Senate Democrats’ latest bill to lower prescription drug prices removes a provision to cap patients’ insulin costs at $35 per month, legislation that comes amid a push for a separate bipartisan bill on insulin.  

Capping out-of-pocket insulin costs at $35 per month has been a high-profile selling point for Democrats’ economic package and has been touted by President Biden, so removing it carries some risk.    

The provision is part of a separate bipartisan bill from Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine), which is moving forward and could get a vote in the Senate this month.

But the Shaheen-Collins bill will require support from at least 10 Republican senators in order to clear a filibuster and pass. By contrast, the Democratic-only drug pricing measure is part of Biden’s economic package, which uses a process known as reconciliation to bypass a GOP filibuster, meaning it can pass with only 50 Democratic votes.  

It is therefore unclear if going the bipartisan route on capping insulin costs will result in the measure being blocked by Republicans and not becoming law.  

Asked about the provision’s removal from the Democratic-only bill, a Shaheen aide pointed to the Shaheen-Collins bill instead. “The Shaheen-Collins bill, including the $35 copay provision, will be handled via regular order, so that’s why you’re not seeing it,” the aide said.  

While Collins is supporting the bipartisan insulin bill, it is far from clear that nine other Republicans will vote for it, and some have voiced concerns about interference in the free market.  

It is also unclear if Democrats would seek to add the insulin cost cap back into the Democratic-only package if the bipartisan approach fails. There is also some question as to whether the insulin cap could pass muster with the complicated Senate rules governing the process for bypassing a GOP filibuster. 

Aside from the insulin provision, Democrats’ drug pricing bill still includes major provisions to allow Medicare to negotiate lower prices on a subset of drugs, in order to to limit drug price increases to the rate of inflation cap Medicare beneficiaries’ out of pocket drug costs at $2,000 per year.  

The fate of that measure still depends on Democrats reaching a broader deal with Sen. Joe Manchin (D-W.Va.) on other parts of the package, like energy and tax policy.