Republicans Debate Insulin Pricing Cap Ahead Of Daunting Midterms

A group of Senate Republicans wants to ensure private insurance patients with diabetes don't have to pay more than $35 a month for insulin.

The move is a major shift for a party that's long viewed price controls as anathema to free markets. And it's the latest sign that GOP lawmakers are trying to address affordability issues ahead of the midterms.

Last week, four Republicans in the Senate Health Committee voted for an amendment from Vermont Independent Bernie Sanders — a democratic socialist — to a different bill that would have added an out-of-pocket cost cap on insulin for people with private insurance.

Fourteen Republican senators have also signed onto the bill by Jeanne Shaheen (D-N.H.) to establish the insulin cap. A moderate, Maine’s Susan Collins, is the lead GOP sponsor, but the others include a party leader, Policy Committee Chair Shelley Moore Capito of West Virginia, and conservatives like Jim Banks of Indiana.

The support is an indication of how Republicans’ deference to corporations and free market orthodoxy is waning in the Trump era.

Unlike his GOP predecessors, President Donald Trump has repeatedly taken aim at corporate America. Republican advocates of the insulin price cap are poised to follow his lead.

“I don’t know why it should divide Republicans,” Missouri’s Josh Hawley, one of the four GOP senators who supported the insulin amendment, told POLITICO. “Who is in favor of allowing these pharma companies to rip off people with high insulin prices when there is no supply issue or production issue?”

Polling has consistently shown health costs are a top issue for voters ahead of the 2026 midterms. At the same time, Republicans increasingly say the affordability of a lifesaving drug like insulin overrides concerns about violating free market principles.

“I think it’s just responding to the need,” Capito told POLITICO. “I don’t see anything wrong with it.”

Some red states have already capped insulin costs.

Capito’s West Virginia counterpart and fellow sponsor of the Shaheen bill, Jim Justice, signed into law a similar cap when he was governor in 2020. Many Americans have diabetes and “medical costs can spiral out of control,” he said.

Collins has pushed for curbing insulin costs for years, but this latest bid comes amidst a tough re-election battle in a seat Democrats hope to pick up. Recent polling has shown a tight race between her and Democratic nominee Graham Platner, who has made affordability central to his campaign.

But despite increased GOP support in recent weeks, the Shaheen bill has yet to make it to the Senate floor.

The panel’s chair, Bill Cassidy of Louisiana, decried the effort to add the policy without a more comprehensive understanding of what Americans stood to benefit and whether it would cost the government money.

After voting against Sanders’ amendment last week, Cassidy indicated he could be open to moving forward a version of it after his committee obtains more information about its impacts from the Congressional Budget Office, a nonpartisan arbiter of what bills cost.

“The chairman is committed to making insulin more affordable for families," Cassidy spokesperson Stephen Lewerenz told POLITICO following the markup, noting that the first steps toward making that a reality are resolving outstanding policy questions and getting a CBO score.

In addition to the cost cap, the Shaheen legislation includes a $100 million grant program that offers $35 insulin to uninsured residents in 10 states.

During last week's Health Committee vote, Cassidy pointed out that existing programs already reduce the cost of insulin for many Americans.

Medicare’s prescription drug program has a $35 cap thanks to the Inflation Reduction Act, which a Democratic Congress and then-President Joe Biden enacted in 2022 without any Republican support.

“Most commercial insurance companies voluntarily cover insulin for only $35 out-of-pocket,” Cassidy noted during the committee hearing, adding that he supports efforts to cap insulin costs at $35. “TrumpRx and other direct-to-consumer platforms make insulin available for $25 today.”

Cassidy indicated that there may be another chance next month for his committee to weigh funding extensions for various public health programs, but it's unclear whether other legislation, such as the INSULIN Act, will be considered.

Other Republicans echoed the argument that TrumpRx could be sufficient for reducing insulin costs.

Kansas Sen. Roger Marshall said a major driver of drug costs is pharmacy benefit managers, the middlemen that negotiate with drugmakers on behalf of employer plans. Reforms to their business practices have garnered wider Republican support than out-of-pocket caps.

He added there could be an ideological divide over the idea of a cost cap in the Republican conference.

“It’s something we debate and try to find the sweet spot,” Marshall said.

Insulin also offers a unique opportunity to correct anticompetitive behavior from insurers, said GOP health strategist Joel White, a partner with the consulting firm Monument Advocacy.

“Most people in the US have coverage, and what they pay isn't the price of the drug, it's the price (copay) set by the insurance company, or the insurance price,” White said in a statement. “What we saw in the insulin market was massive rebating schemes and efforts to thwart drug manufacturer price reductions.”

While Republicans think price controls reduce access and limit innovation, the insulin cap is more of an effort to correct bad market actors, he added.

At least one major insulin manufacturer, Eli Lilly, said it supports efforts to lower patients' out-of-pocket costs.

“Lilly was the first company to cap what patients pay at $35 per month for all of our insulins and has been working for years to reduce insulin out-of-pocket costs for people with diabetes, against the headwinds of those that benefit from rebates and choose higher list-price medicines over lower-priced options,” Eli Lilly spokesperson Jared Shapiro said in an email.

Shaheen, who is retiring after this term, is buoyed by the additional bipartisan support.

“The debate on the INSULIN Act is a positive step and I appreciate Chair Cassidy’s commitment to work in good faith on our legislation in an effort to move it forward,” she said in a statement to POLITICO.

While an out-of-pocket cap on insulin costs may appear like price control to some Republicans, in practice the legislation would likely shift the cost from individuals to the broader pool of beneficiaries within an insurance plan. Premiums would potentially rise if the bill becomes law and the cost burden shifts from individuals to the broader pool of insured individuals.

Even if the Senate ultimately passes the legislation, questions remain about whether the House will take it up. The GOP has a narrow majority there and House leaders, like their Senate counterparts, are typically reluctant to bring bills to the floor that divide their party.