INS and heart failure: Initial evidence on the effects of the $35 insulin cap in early 2023 show that it was associated with increased insulin fills.27 This aligns with earlier evidence, which has shown that reductions in insulin OOP costs are expected to lead to improved insulin adherence and large reductions in strokes, heart attacks, heart failure, and end-stage kidney disease.28,29 Another recent study30 estimated that for individuals with at least 1 cardiovascular risk factor, those spending more than $2000 per year would have a median reduction in OOP costs of $855 per year under the IRA.