Insulin price cap championed by Collins stripped from spending bill by fellow Republicans

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Aug. 10—Maine's U.S. senators both support proposals to cap insulin prices and have each introduced legislation over the past two years to do so, but it wasn't enough to secure passage of the measure as part of the Democrats' climate change, tax and health care bill Sunday.

Forty-three Republicans voted to strip out the measure, which would have capped insulin at $35 per month. While a majority of senators supported it, the chamber's parliamentarian ruled it didn't meet the criteria for inclusion in the so-called reconciliation process, which meant it needed a filibuster-proof 60 votes to remain in the bill. It got only 57.

Sen. Susan Collins was among seven Republicans who voted with all 50 Democrats to keep the measure in the bill, even though she and all other Republicans ultimately voted against the reconciliation package. Collins had introduced a separate bill to cap insulin prices and said it was unfortunate that it had been included in the much larger spending bill.

Senate Majority Leader Charles Schumer, D-N.Y., has since pledged to hold a vote on stand-alone legislation to secure the price cap on insulin, which diabetics must take regularly to avoid severe sickness, amputation of limbs and death.

In an interview with the Press Herald on Tuesday, Collins was upbeat about the stand-alone bill's prospects for securing the 10 Republican votes needed for passage.

"The reason I am hopeful is that if we got seven Republican votes during this highly partisan reconciliation process that involved waiving the budget point of order, I am hopeful that we can get at least 10 Republican votes if we take up the bill in the normal fashion," Collins said. "Frankly, based on my individual meetings with Republican senators to go through our bill, I believe and am hopeful that we will get more than 10."

U.S. drug makers boosted the cost of single vial by over 1,000 percent between 1999 and 2019, even as the price remained flat in Canada and other developed countries.

Collins' office also spotlighted a tweet by a Republican senator who voted to strip the insulin measure from the Democrat's bill. In the tweet, Iowa's Chuck Grassley said the vote had not been about insulin but rather "Dems ignoring budget rules." He called on his colleagues to join him in supporting the stand-alone bill previously drafted by Collins and Sen. Jeanne Shaheen, D-N.H., who together chair a Senate caucus on diabetes.

The Press Herald reached out to two other Republican senators who had voted to strip the insulin cap Sunday. Mitt Romney of Utah didn't respond, but a spokesperson for Rob Portman of Ohio — who is not running for re-election — said via email that the senator instead supported a Republican alternative that was more targeted, geared toward low-income Americans who are most in need. It was not clear if this alternative referred to the Collins-Shaheen bill and the spokesperson, Mollie Timmons, didn't respond to a follow-up question.

The Collins-Shaheen bill, unveiled in June, aimed to entice drug makers to lower their list prices by blocking pharmacy benefit managers from accepting rebates or fees from drug makers that encourage higher prices. It also capped insulin co-pays imposed by private insurance companies to $35.

"Skyrocketing insulin prices put lifesaving medication out of reach for millions of Americans living with diabetes," Shaheen said in a written statement to the Press Herald. "I'm disappointed legislation that would have provided a $35 co-pay cap on the price of insulin in the private market was not included in the (reconciliation bill), but I'm optimistic we can capitalize on the bipartisan support for the measure by now passing my standalone legislation with Senator Collins."

Shaheen said she hoped to build support for the bill alongside Collins when the Senate reconvenes in September.

Collins said their bill's provision to stop rebates, fees and other pricing incentives was essential in getting at the underlying problem and would benefit all users of insulin, including the uninsured, who have to pay the list price of the drug out of pocket. "Putting on the price cap helps people who are in certain insurance plans, but it is even more important that we address what is a conflict-ridden drug pricing system," she said.

King was one of the original co-sponsors of the bill that became the basis of the $35 cap voted on Sunday, the Affordable Insulin Now Act introduced in February by Sen. Raphael Warnock, D-Georgia. That act, King said at the time, was modeled on Maine's law that caps insulin at this price.

"This was not a partisan issue in Maine, and it should not be a partisan issue nationwide," King, an independent, said in a statement at the time. "The bill would save and extend lives, lower costs for working Maine families, and represent a significant step towards more affordable healthcare for Americans." In addition to King, 35 Democrats co-sponsored the bill but no Republicans.

The reconciliation bill passed Sunday — a scaled-back version of Build Back Better that Democrats have dubbed the Inflation Reduction Act — did cap out-of-pocket insulin payments at $35 for Medicare patients, of whom more than 3.3 million receive the drug.

In addition to Collins, the Republicans who voted to preserve the cap Sunday were Josh Hawley of Missouri, Cindy Hyde-Smith of Mississippi, Lisa Murkowski and Dan Sullivan of Alaska, and John Kennedy and Bill Cassidy of Louisiana. The measure fell three votes shy of the 60 required for it to stay in the bill.