After years of political pressure, insulin prices are finally starting to drop. But not all New Yorkers with diabetes are benefiting from the new prices.
What the Medicare price cap means for New Yorkers
The cap also only applies to insulin products that are covered by a patient’s insurance. Like other health plans, individual Medicare Advantage plans frequently switch out which drugs are covered, depending on the prices negotiated by pharma middlemen. Often plans will swap one medication for another that’s deemed clinically similar.
To help patients benefit, Eli Lilly and Sanofi promised to cap the out-of-pocket cost of a monthly supply of insulin at $35 for people on commercial insurance, who were left out of the federal legislation targeting Medicare patients. Eli Lilly’s price cap took effect immediately, while Sanofi’s will go into effect in January 2024.
Olsson, who has an Aetna plan through her employer, said she also uses a glucose monitor and has a prescription for a long-acting insulin and the anti-obesity drug Ozempic, which is in a different class of medications than insulin. All come with their own fees. New Yorkers without insurance can also access drug discount programs, but New York Attorney General James has raised concerns that not everyone who qualifies is aware of them. Dang of the Hell’s Kitchen pharmacy said he often has to educate patients about the savings available, some of which are based on income.
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