More States Considering a Cap on Insulin Costs

The average monthly cost of insulin between 2012 and 2016 rose from around $238 to $475, despite no changes being made to the drug.

The average monthly cost of insulin between 2012 and 2016 rose from around $238 to $475, despite no changes being made to the drug. Shutterstock

 

Connecting state and local government leaders

A new bill in Washington is similar to legislation passed in Colorado last year.

Over the past decade, the price of insulin tripled. For all of the 1.25 million Americans born with type 1 diabetes—and some of the millions who develop  type 2 diabetes as adults—insulin is crucial to survival, but the rising costs are putting the drug outside the range of affordability for many.

A state lawmaker in Washington wants to cap the out-of-pocket costs many patients pay for insulin to $100 per month, saying she hopes this would prevent residents from rationing their use of the life-saving drug. “This is a crisis,” state Sen. Karen Keiser said in a statement announcing the bill. “My colleagues and I hear every day from constituents who can’t afford their medication anymore, people who have to choose between prescriptions and rent.”

Under the bill, a health insurance plan issued on or after January 1, 2021 that provides coverage for insulin must cap the copays, deductibles “and other forms of cost sharing” for the drug to $100 per 30-day supply. This would reduce costs for many, as the average monthly cost of insulin between 2012 and 2016 rose from around $238 to $475, despite no changes being made to the drug.

“The legislature finds that diabetes imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and that access to the medically accepted standards of care for diabetes, its treatment and supplies, and self management training and education is crucial to prevent or delay the short and long-term complications of diabetes and its attendant costs,” the bill reads. 

The text of the bill is similar to one that was passed into law in Colorado last year, which made the state the first to cap insulin prices at $100 per month. In signing the bill, Gov. Jared Polis announced that “the days of insulin price-gouging are over in Colorado.” 

Colorado lawmakers said they received inquiries from state lawmakers across the country after the bill was passed. Pennsylvania lawmakers introduced a bill to cap insulin in September 2019, but the bill has not left committee. Illinois lawmakers passed a similar measure in November 2019, which Gov. J.B. Pritzker said he would sign but has not yet.

Critics of initiatives to cap insulin prices have expressed fear that pushing the cost of the drug onto insurers will raise rates. Early results out of Colorado, however, suggest that hasn’t happened. In its filings for proposed 2020 rates for individual and small-group market plans Kaiser Permanente wrote that “it is expected that the cost sharing caps will have a de minimus (negligible) impact on rates.”

Other critics have complained that the laws aren’t broad enough. In Colorado and Illinois, the laws only cover people with private health insurance, such as those who buy their own plans or some who get coverage through employers, but excludes those with Medicare and Medicaid and people covered by employer-funded insurance that is federally regulated. 

In comments on the Colorado Division of Insurance’s proposed rules for implementing the law in Colorado, the diabetes charity T1International that the law “does not sufficiently cover all people with diabetes or using insulin.”

In Illinois, it was estimated that the law, if signed by the governor and put into effect on January 1, 2021, would only regulate costs for 260,000 insulin users, or about 20% of the state’s 1.3 million users. The bill’s sponsor, state Rep. Will Guzzardi, said in a Facebook video posted after the bill’s passage that it wasn’t a one-size-fits-all solution. “It’s not going to fix the whole problem,” he said. “Certain people won’t be covered, certain people will. But for those who will be covered it’s going to be a big step forward to make sure they’ll be able to afford the lifesaving medicine that they need.”

Some insurance companies have begun to voluntarily cap the price of insulin. The nonprofit health plan UCare in Minnesota announced that, starting in 2020, insulin costs would have a ceiling of $25 per month for their 33,000 plan holders, making them the second insurance company in the state to do so. The health insurance company Cigna also created a plan in 2019 that would cap the monthly cost of insulin at $25 for the roughly 700,000 eligible to enroll in a non-government-funded pharmacy plan managed by Express Scripts.

But state lawmakers like Keiser in Washington say legislative action is needed now.  “We have a responsibility to curb excessive costs of critical prescription drugs that are vital for people’s health,” she said.

Emma Coleman is the assistant editor for Route Fifty.

NEXT STORY: In Reversal, Counties and States Help Inmates Keep Medicaid

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.