Q&A: Making Insulin Affordable

Q&A: Making Insulin Affordable

With U.S. Sen. Chuck Grassley

Q: Does the INSULIN Act reduce drug prices for people with diabetes?

A: As a co-sponsor of this bipartisan legislation, I'm continuing my efforts in Congress to help lower the cost of insulin for the tens of millions of Americans who rely on this lifesaving medication to thrive and enjoy a high-quality of life. According to the U.S. Centers for Disease Control and Prevention, nearly 12% of the U.S. population lives with diabetes.

The Improving Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act would cap the cost of insulin at $35 per month nationwide, applying this out-of-pocket threshold for Americans on private and employer insurance. It also would create a five-year pilot program in 10 states to help make insulin available at the same cost to Americans without insurance. When enacted, patients starting in 2028 would pay the lesser of $35 for a 30-day supply, or 25% of the negotiated net price. This legislation builds on momentum I led during my chairmanship of the Senate Finance Committee to drive down prescription drug costs. My two-year bipartisan investigation with Sen. Ron Wyden of Oregon examined the surging list price of insulin - a drug that's been available for more than a century. Our investigation identified anticompetitive business practices between manufacturers and middlemen known as Pharmacy Benefit Managers (PBMs) that's created an unsustainable cycle of price increases for patients and taxpayers. This investigation continues to be cited as evidence for PBM reform at the state and federal levels, including by the Federal Trade Commission, U.S. Department of Labor and the Iowa Attorney General.

I continue pushing to fix the broken system. In the past few years, legislation I've secured into law has saved taxpayers over $11 billion. The INSULIN Act would build on these legislative efforts to rein in and reform the business practices that enable PBMs to profiteer from rebate arrangements with drug companies. The pricing scheme encourages drug makers to spike the list price of a drug to offer a greater rebate. In so doing, they secure a priority placement on a health plan's list of covered medications. This arrangement translates into sticker shock at the pharmacy counter for patients and leads to a bigger tab for taxpayers to foot. That's why I've worked to bring accountability and transparency to the U.S. drug supply chain. So far, a handful of bills I've supported have become law, including the CREATES Act, the Right Rebate Act, Patient Right to Know Drug Prices Act, provisions from the Prescription Drug Pricing Reduction Act, and recent PBM reform included in the Fiscal Year (FY) 2026 funding package. The INSULIN Act is part of a dozen additional bills I'm supporting at the policymaking table to help drive up innovation and drive down the cost of prescription medicine for families stretching every dollar to afford lifesaving medication.

Q: How does the INSULIN Act promote savings and innovation?

A: In addition to the payment cap, the comprehensive legislation would ensure patients benefit from the insulin rebates and discounts that are collected by PBMs. It would require PBMs to pass these on to insurance plan sponsors so that patients share in these savings. It also seeks to boost competition for biosimilar insulins. Although insulin was discovered a century ago, the pathway to bring more affordable versions to market is more complicated than other types of pharmaceuticals. That's one reason branded versions of insulin have had a lock on the market for decades. Insulin is in a category of medicines known as biologics, comprised of complex molecules made from living organisms. So, unlike generic versions of pharmaceutical drugs comprised of chemicals that may use the same active ingredients as a brand-name drug, biologic drugs have a more difficult path to replicate. A copy of a biologic drug is typically called a biosimilar. I've pushed for reforms to provide a faster pathway to get biosimilars to market that uphold the safety, purity and potency of the original drug.

For example, my bipartisan Preserve Access to Affordable Generics and Biosimilars Act would limit anticompetitive pay-for-delay deals that prevent or delay the introduction of affordable generic drugs that are 80% cheaper than their branded counterparts. My Stop STALLING Act would deter branded pharmaceutical companies from filing sham "citizen petitions" with the FDA to interfere with the approval of generic and biosimilar medicines that compete with their own brand products. It would give the Federal Trade Commission enhanced authority to act against those who file sham petitions.

Throughout our nation's 250 year history, our free marketplace and intellectual property framework have enabled the ingenuity and innovation of Americans to pioneer lifesaving cures and treatments. We need to continue this legacy. That's why I'm working to strengthen competition and a pathway to affordable access to pioneering medicines for generations to come.

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