Last week Colorado became the first state to pass legislation aimed at helping diabetic residents cope with the high cost of prescription insulin. The new law limits out-of-pocket payments for the drug at $100 per month for patients with private health insurance, starting January 2020. Insurance companies will cover any additional costs beyond the cap.
Also under the law, the Colorado Attorney General will launch an investigation into insulin pricing practices, then make recommendations to the legislature.
It’s unclear whether the $100 cap will apply to Medicare Part D recipients. Because that is a federally sponsored program, some experts predict the private insurers who offer insulin on Medicare Part D plans will be exempt. Others believe insurers will likely voluntarily comply with the law. The law applies only to insulin, not other diabetes medications.
About 7.4 million diabetics must take insulin every day to live, said LaShawn McIver, MD, Senior Vice President of Government Affairs & Advocacy for the American Diabetes Association, which supported the Colorado legislation.
The price of insulin has tripled from 2002 to 2013 according to a 2016 study published in the medical journal JAMA in 2016. Prices have continued to rise dramatically since that study, nearly doubling between 2012 and 2016, according to a House of Representatives report released in March.
People with diabetes often face financial hardships affording their insulin, said McIver. “Many are faced with tough decisions to either cut back or skip doses, or forgo other necessities to pay for insulin.”
Approximately 25 percent of people living with diabetes are rationing their medication either by reducing the amount of insulin they take in each dose or reducing the frequency of taking insulin, according to American Diabetes Association research. Rationing insulin can lead to serious complications and if not addressed, may lead to death.A number of states and companies are taking action to lower skyrocketing insulin costs, starting with Colorado. #diabetes Click To Tweet
The Colorado action, known as HB19-1216, is thought to be the only law of its kind. It’s unclear which, if any, other states have similar bills in the works.
This spring, Minnesota came close. The Minnesota House passed the Alec Smith Emergency Insulin Act that would create a statewide insulin assistance program for people having trouble affording their insulin. The act did not get a hearing in the Senate, however, and was omitted from the Final Senate Omnibus HHS budget, where it had been proposed as an amendment.
The Act is named after a Minnesota resident who passed away in 2017 at age 26 after he began rationing his insulin because he could not afford the dosage he needed. Smith’s death sparked nationwide discussion of skyrocketing insulin prices, including within the pharmaceutical industry.
In April pharmacy benefit manager Express Scripts announced it will place a $25 per month cap on out-of-pocket costs for insulin. And in March, Eli Lilly, one of the largest manufacturers of insulin, announced it will offer a version of its Humalog product, called Insulin Lispro at half the price, or $137.35 a vial.
Denver resident and patient advocate Gail DeVore, who has taken insulin for the past 47 years after she was diagnosed with Type 1 Diabetes at age 11, says that these efforts don’t go far enough. “Not everyone has access to the Express Scripts benefit,” she explained. And even half price for Eli Lilly’s product is still out of reach for many diabetics, she said. “Co-pays add up really fast for a month’s worth of medicine.”
DeVore, who is active in several diabetes and patient advocacy organizations, recently testified in front of a House subcommittee hearing held on the skyrocketing costs of insulin, saying she hears from people every day who can’t afford the high price of a medicine they desperately need.
Some experts worry the Colorado law, although helpful, doesn’t address the underlying problem of rising pharmaceutical drug costs. What’s more, insurance premiums for all Colorado residents may rise as a result of the law.
DeVore understands that viewpoint but added, “Insulin is a hormone every human needs to stay alive. It should be affordable, period.”
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