$35 a month insulin: What to know about reduced costs

Drugmaker Eli Lilly said Wednesday that out-of-pocket costs for its insulin would be immediately capped at $35 a month, a 70% reduction. Here are some questions and answers about the announcement and what it could mean.

Didn’t Congress already limit the cost of insulin?

Sort of. The Inflation Reduction Act of 2022 lowered insulin prices to a monthly maximum of $35 for out-of-pocket costs, but only for diabetic seniors with Medicare, expecting to benefit 1.5 million people. Uninsured diabetics or those who have private medical insurance weren’t covered.

How do I take advantage of the new insulin policy?

For diabetics covered by private insurance, Lilly will automatically cap the out-of-pocket costs at $35 a month at participating retail pharmacies. Uninsured diabetics can visit InsulinAffordability.com and download the “Lilly Insulin Value Program” savings card to take advantage of the cap.

What is diabetes?

According to the Centers for Disease Control and Prevention: “Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy. Your body breaks down most of the food you eat into sugar (glucose) and releases it into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy. With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should.”

What can happen without insulin — or if cells stop responding to insulin?

Excessive blood sugar in the bloodstream can lead to serious health problems such as vision loss, kidney disease and heart disease, the CDC says.

What will the cap mean for diabetics who rely on insulin?

Ismaeel Yunusa, an assistant professor of clinical Pharmacy and Outcomes Sciences at the University of South Carolina’s College of Pharmacy, told Newsday that the cap will not only increase affordability for diabetics but also “lead to improvement in getting the medication that they need,” and reduce the chances they’ll ration insulin.

How many diabetics have ever rationed their insulin due to the cost?

About 16.5% of diabetics, or 1.3 million people, have taken less insulin than medically necessary due to cost, according to a November 2022 analysis in the Annals of Internal Medicine of Centers for Disease Control and Prevention data, Yunusa said.

How many Americans have diabetes — and how many need daily insulin?

There are more than 30 million American diabetics, of whom more than 7 million require daily insulin, according to a Yale University article, which found that for 14% of diabetics who use insulin, it's "an extreme financial burden."

How much have costs risen?

In 1996, when Lilly's Humalog brand of fast-acting type of insulin debuted, a vial cost $21, according to the Yale article. By last summer, that same vial had risen to cost almost 10 times that.

By Matthew Chayes

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Matthew Chayes, a Newsday reporter since 2007, covers New York City.