Philadelphia retired nurse: I’m saving tens of thousands thanks to a Harris-backed drug cap

In his more than 30 years as a Philadelphia nurse, Steve Lubin often saw patients in intensive care, with organs failing, because they couldn’t afford to pay for medications.

“I saw people whose kidneys were shot, and others with vascular and heart problems, because they had been trying to ration drugs they couldn’t afford,” he says. “Sometimes they didn’t take their drugs at all.”

Today Lubin, 70, retired and on Medicare, is grateful for the Biden-Harris prescription drug caps – and not only because fewer economically strapped patients will end up with life-threatening conditions. 

Lubin himself now depends on insulin to treat his type 2 diabetes, and appreciates knowing he won’t have to pay more than $35 a month for it.

“My income is limited, and every time I spend more on health care, I have less for other things I need to do – like car repairs,” he says.

A Big Cut on Prescription Costs

In Pennsylvania, as throughout the United States, the soaring price of insulin has forced seniors with diabetes to make painful choices. This is the result of a shameful systemic problem: Americans pay 2.56 times more for prescription drugs than those in 32 other countries.

The Biden-Harris administration is cutting prescription drug costs.

Earlier this year, the Inflation Reduction Act began easing the pressure. Dramatic new price cuts will help up to 154,000 Pennsylvania Medicare beneficiaries who depend on insulin to treat their diabetes.  

Medicare recipients now need pay no more than $35 a month for insulin—down from an average of $54. 

In another major benefit, out-of-pocket costs for all drugs under Medicare Part D, which helps pay for prescriptions, will be capped at $2,000 per year, beginning in 2025. That will help tens of thousands of Pennsylvanians every year.

“These proposed solutions are definitely a step in the right direction and address a big harm, which is when people ration because of affordability,’ Dr. Jing Luo, an assistant professor of medicine at the University of Pittsburgh, told a reporter earlier this year.

These changes are just the start of cost-saving reforms: 

• Biden’s Inflation Reduction Act will cap costs for 10 other medications for Medicare recipients, beginning in 2026. 
• The 10 drugs, which treat illnesses including heart failure, blood clots, arthritis, and Crohn’s disease, represent the highest spending for drugs in Medicare Part D.
• Over the next four years, Medicare plans to tackle prices for up to 60 other drugs, with 20 more every year thereafter.
• As of 2023, out-of-pocket costs for vaccines, such as shingles, under Part D, have been eliminated, helping scores of thousands of state Medicare beneficiaries.
• Some 346,000 Pennsylvanians will save hundreds of dollars on average on their Marketplace health care premiums next year, thanks to subsidies continued by the Inflation Reduction Act. For middle-income people facing high premiums, those savings increase to thousands of dollars per year.  

For now, the Biden-Harris prescription medication relief affects only older Americans. But Democrats want to extend it to all ages, so no one has to choose between staying healthy and housed and fed.

Last March, Penn. State Rep. Jeanne McNeill reintroduced a law to cap the out-of-pocket insulin costs for all patients who need it at $35 a month. A majority of Pennsylvania’s Republican lawmakers have opposed these efforts, even as 21 other states, including New York and Oklahoma, have passed them.

As part of her campaign, Vice President Kamala Harris has proposed capping insulin costs at $35 dollars and capping out of pocket prescription drug costs at $2,000 for all Americans.

How You Can Take Advantage of This Help

If Medicare is paying for your insulin:

• Your bills should already be lower.
• The new cap kicked in for Part D (drugs) recipients in January and for Part B (outpatient) recipients who receive insulin through a pump, in July.
• Check your monthly statements and call your doctor’s billing office if you have questions.
• If your doctor can’t help, contact Medicare at 1-800-633-4227 or 1-877-486-2048 (TTY), or the Pennsylvania consumer service for health care coverage at 1-866-550-4355.