Dear Congressional Leaders, Committee Chairs, and Ranking Members,

We write to urge immediate action to address the insulin affordability crisis that endangers the lives of millions of Americans. With over seven million people in the United States relying on injected insulin to stay alive, this issue demands your urgent attention.

The crisis is stark: One in four Americans who rely on insulin to survive, ration it due to cost, often with significant health consequences.

This is a failure of competition and a failure of regulation. Insulin manufacturers use tactics such as patent evergreening, product hopping, and pay-for-delay to prevent lower-cost biosimilars and generics from entering the market. These monopolistic practices have kept prices high and patients in peril. Meanwhile, enforcement actions remain insufficient.

By July recess, we need Congress to take decisive action to draft and pass comprehensive legislation that can be implemented by World Diabetes Day on November 14 to:

1. Establish national caps on all insulin copays to alleviate immediate financial burdens for patients, including for the uninsured, while recognizing that copay caps do not address the underlying problem of inflated list prices.

2. Implement reforms to curb patent abuses, including evergreening, product hopping, and other anti-competitive practices that stifle biosimilar competition and maintain monopolies.

Failure to act is not an option. The health and financial costs of inaction—preventable hospitalizations, diabetes-related complications, and premature deaths—are borne not only by individuals but by our entire healthcare system and economy.

We call on you to use your leadership to advance these reforms and ensure that no American is forced to ration or forgo the insulin they need to live.

Sincerely,