Insulin cost cap, other federal health care affordability rules finalized

This week, federal health officials finalized a set of rules tied to the last leg of the 2022 Inflation Reduction Act. The list includes a cap on insulin cost at $35 a month.

They’re meant to lower out-of-pocket costs, streamline care for people on both Medicare and Medicaid, and make other policies more permanent.

“It's going to impact our patients a lot,” said Casey Simon with Prisma Community Care, a Phoenix community health clinic. “As we have patients that are aging kind of into chronic conditions, things like insulin are going to become more of a talking point for a lot more folks, as the years go on. So, I mean, we're happy to see it and want to continue to see more things that are codified into law.”

Simon said codifying rules like this is key to make health care planning stable and ensure the best outcomes for patients.

It helps preserve access to care in areas the changes affect – medication costs, prescription plans, and insurance coverage – by creating a stable infrastructure around them, he added.

“If they're unsure, if costs start to creep up and that becomes the, like, panic notion where it's like, ‘I can't go back there. I owe money,’” Simon said of the mindset many people can fall into. “Like, ‘I can't afford to pay that.’ That's not what we want. We want you to reach out to us.”

He said insurance can often feel confusing by design, but steady access to health care is more achievable than many realize, especially with patients and providers on the same page.

“In the long run,” said Simon, “we want to make sure that we're providing the patients early on in disease diagnosis and management with the best care so that we're reducing the cost of long-term problems that could result.”

Simon said codifying rules like this is a key step to make health care planning stable and ensure the best outcomes for patients.