President Joe Biden is campaigning on his success in getting seniors with diabetes a $35-per-month cap on their insulin spending. But his Republican opponent, former President Donald Trump, claimed Saturday that Biden has actually done nothing to lower insulin costs and that Biden is taking credit for Trump’s own accomplishment.
“Low INSULIN PRICING was gotten for millions of Americans by me, and the Trump Administration, not by Crooked Joe Biden. He had NOTHING to do with it,” Trump wrote on social media. “It was all done long before he so sadly entered office. All he does is try to take credit for things done by others, in this case, ME!”
Facts First: Trump’s claims that Biden did nothing to lower insulin costs and “it was all done” before Biden became president are both false. Trump did get a $35-per-month cap on insulin for some seniors, through a voluntary program that Medicare prescription drug plans could choose to participate in. But Biden ensured that all 3.4 million-plus insulin users on Medicare got $35-per-month insulin — through a mandatory cap that not only covers more people than Trump’s voluntary cap but also applies to a greater number of insulin products and stays in effect at a level of individual drug spending at which Trump’s cap disappeared.
Trump could fairly say he played a role in lowering insulin costs and that Biden does not deserve sole credit. The Biden-era federal government has acknowledged that Biden’s mandatory $35 monthly cap, signed into law in his Inflation Reduction Act of 2022, “closely aligns with” the voluntary $35 monthly cap in the Trump-created program that was announced in 2020 and launched in the final month of the Trump presidency in 2021.
But Trump’s claim that Biden deserves no credit at all is inaccurate. Biden’s policy goes beyond Trump’s policy in multiple ways.
Asked for comment, a Trump campaign spokesperson provided an emailed statement that asserted Biden had replaced Trump’s insulin cap with a “weaker” policy. But after CNN outlined the ways Biden’s policy is demonstrably stronger than Trump’s, and asked how it could reasonably be considered “weaker,” the Trump campaign did not reply further.
Biden’s policy was passed by Congress and signed into law, making its future more secure than the Trump initiative that was created without new legislation and that was described as a five-year test. And here are four substantive ways Biden’s policy does more than Trump’s did.
1: Biden’s policy applies the $35-per-month cap to every insulin user in Medicare Part D. Trump’s policy didn’t
Biden’s policy, which took effect in 2023, requires every prescription drug plan in Medicare Part D to provide each insulin prescription for no more than $35 per month. Conversely, in 2022, 38% of Part D prescription drug plans chose to sign up for the voluntary Part D Senior Savings Model program initiated by Trump, according to data provided to CNN by Juliette Cubanski, deputy director of the Program on Medicare Policy at health policy organization KFF. Only “enhanced” plans were allowed in, not basic plans.
The federal Centers for Medicare & Medicaid Services told CNN that in 2022, before Biden’s policy took effect, more than 800,000 people with diabetes in Part D were eligible for $35-or-less insulin through the program initiated by Trump. And some substantial additional number of seniors, which is not publicly known, were paying $35 or less per month for reasons other than that Trump program.
Regardless, Biden made $35-per-month insulin universal for seniors with diabetes. Trump did not.
2: Biden’s policy applies the $35 cap to Medicare Part B. Trump’s policy didn’t
Biden’s policy imposes the mandatory $35 monthly cap on insulin taken via a pump, which is obtained through Medicare Part B. Under Trump’s program, the voluntary $35 monthly cap only applied to insulin obtained via Medicare Part D drug plans, such as insulin that is injected or inhaled.
“The Inflation Reduction Act, which the American Diabetes Association supported, expanded and made permanent the cost-sharing limits for insulin users enrolled in all Medicare Part D plans and those who take insulin under Part B,” the association said in an email, underlining the word “all.”
3: Biden’s policy requires a $35 cap on all covered insulin products. Trump’s policy only required it on some
Biden’s policy applies the $35 monthly cap to all insulin products covered by Part D prescription drug plans. Under Trump’s program, even the drug plans that volunteered to participate could choose to apply the $35 monthly cap to just one particular vial product and one particular pen product of each insulin type (rapid-acting, short-acting, intermediate-acting and long-acting).
If a senior happened to use a different product that was not designated for the $35 cap, they would have to switch products if they wanted to benefit from the cap. Cubanski and KFF colleagues wrote in 2020: “Making this switch could be difficult for insulin users who have been stabilized on a particular insulin medication (or medications) and for whom consistency in treatment is important in managing diabetes.”
4: Biden’s policy eliminates insulin payments for patients at the “catastrophic” level of drug spending. Trump’s $35 cap didn’t exist at the “catastrophic” level
Under Biden’s policy, people in Medicare Part D no longer have to make any payments for covered prescription drugs, including insulin, once they reach a very high level of annual drug spending known as the “catastrophic” level. Under Trump’s voluntary insulin program, the $35 monthly cap was no longer in effect after people reached the “catastrophic” threshold, though many people likely paid less than $35 per month for insulin at that point regardless.
In addition, starting in 2025, Biden’s Inflation Reduction Act imposes a $2,000 annual cap on overall out-of-pocket drug spending for people in Medicare Part D. The American Diabetes Association said it was “very pleased” by this overall cap: “An established annual out-of-pocket maximum can provide significant economic relief to individuals living with diabetes who are more likely to require multiple prescription medications.”
Looking forward: Biden wants to expand the $35 cap; Trump’s position is unknown
After the passage of the Inflation Reduction Act in 2022, the country’s three largest insulin manufacturers instituted price caps or launched savings programs that lowered the cost of the drugs to $35 for many patients not in Medicare and slashed the list prices of their products.
Biden is calling to extend the mandatory $35 monthly cap to Americans with private health insurance. In 2022, a proposal to do that failed in the Senate because of opposition from most Republican senators.
It’s not clear where Trump stands on the future of insulin policy; his campaign did not respond to CNN’s request to clarify. But he has called the future of the Inflation Reduction Act as a whole into doubt by repeatedly criticizing the law and some of its key provisions, vowing to pause “all new spending grants and giveaways” under the law, and broadly declaring he will terminate Biden’s environmental policies, some of which are contained in the law.
