Insulin fix could be slipping away

You can put insulin a bit lower on your lame duck radar. Action to lower the cost is facing long odds in Congress before the end of the year, according to congressional aides.

Why it matters: More than 1 million Americans have to ration insulin because of the cost, according to an October study in the Annals of Internal Medicine, and the odds of action are getting even harder next year given the GOP takeover of the House.

Between the lines: Sens. Jeanne Shaheen and Susan Collins have a bipartisan measure to lower insulin costs, but finding nine other Republicans to get to 60 votes has been challenging.

• There isn't a lot of time on the Senate floor before the end of the year, and the CBO found that the measure would cost about $23 billion over 10 years, adding hurdles.
• "It will be a big lift because it’s an expensive policy and Republicans will have to bring 10 votes, which they weren’t able to do earlier this year," a Senate Democratic aide said.
• Another path would be getting the bill into the year-end government funding package, but the odds are not seen as high that GOP Leader Mitch McConnell would agree to that.
• Sen. Raphael Warnock has also made capping insulin costs a key issue, adding a political hurdle to getting Republican support, at least before the Dec. 6 runoff election in Georgia.

How it works: The Shaheen-Collins bill includes a $35-per-month cap on patients' out of pocket costs for insulin, as well as voluntary incentives for drug companies to lower the list price of insulin.

• Some advocates have called for the bill to do more to lower the overall price of insulin, not just cap patient out-of-pocket costs.
• Democrats, including President Biden, have called repeatedly for a $35 cap. Democrats were able to include the cap for people on Medicare in the Inflation Reduction Act, but Republicans voted against overruling the Senate parliamentarian to extend the cap to people with private insurance.
• The odds of action next year are even smaller, given that many Republicans view the policy as interference in the private market. Only 12 House Republicans voted for a $35 cap earlier this year.

• "For any meaningful possible health care agenda, you want to get it done now," said Leslie Dach, chair of the Democratic-aligned advocacy group Protect Our Care.

Yes, but: Senate Finance Committee Chairman Ron Wyden said he is going to go "all in" to push for action on insulin. And Democrats, after keeping their Senate majority, could also seek to pressure the GOP House next year.

• Shaheen sounded a cautious note about the possibility of action before the end of the year, though. "Well, we would still like to see if we can get it done in the lame duck," she told Axios. "I think it depends on timing and what's on the schedule and lots of other things, but yes, we are still pushing it."