It’s no wonder insulin price capping is picking up speed, given that the Health Care Cost Institute placed the average yearly cost of insulin for people with type 1 diabetes at $5,705 in 2016 — double the cost from four years before. RELATED: Why Is Insulin So Expensive? (and What to Do if You Can’t Afford It)
The Latest Bill Signed Into Law Lowers Costs for the Uninsured
On April 15, Minnesota’s governor signed the Alec Smith Insulin Affordability Act into law, enabling uninsured and underinsured people with low incomes to obtain a 90-day supply of insulin through a manufacturers’ patient assistance program for a copay of no more than $50. To be eligible, recipients must have a family income that is equal to or less than 400 percent of the federal poverty level and either be uninsured, not have access to low copays or out-of-pocket expenses, or be a Medicare Part D enrollee with high prescription drug expenses. According to a study published in September 2019 in Diabetes Care, 5 percent of adults ages 26 to 64 with diabetes were uninsured. The law also allows Minnesotans who urgently need insulin and don’t have access to prescription coverage with low copays to obtain a 30-day supply from a pharmacy with a copay of no more than $35 once per calendar year. The measure is named after 26-year-old Alec Smith, who died from diabetic ketoacidosis (DKA) in 2017 after he rationed his insulin because he was unable to afford his $1,300 monthly cost of that medication and diabetes care supplies, NPR reported. DKA happens when the body doesn’t have enough insulin to convert glucose into energy, resulting in a dangerous buildup of acids in the bloodstream known as ketones. “Minnesotans should not die because they are forced to choose between putting food on the table and affording the drug they need to survive,” Governor Tim Walz said in a statement. “Despite resistance from the pharmaceutical industry, the grit and determination of Minnesotans with diabetes, Minnesotans who have lost loved ones with diabetes, and their legislators moved this bill forward. It is downright inspiring.” Earlier this month, Virginia and New York passed similar laws aimed at commercial insurance coverage. The New York measure, which limits copay costs to $100 per 30-day supply, was within the state’s 2021 budget signed by Governor Andrew Cuomo on April 3. Virginia’s law capping copays to $50 per 30-day supply was approved by Governor Ralph Northam on April 8. The American Diabetes Association (ADA) hailed both moves in statements released this week, but also urged both governors to eliminate cost-sharing entirely for insulin during the COVID-19 pandemic. Last month saw a flurry of insulin pricing legislation also aimed at commercial insurance coverage. New Mexico enacted a law that caps insured patients’ copays and out-of-pocket expenses for insulin at $25 for a 30-day supply; Maine capped copays at $35; West Virginia and Washington capped them at $100; and Utah capped copays at $30 for a 30-day supply, unless insurers place insulin in their lowest-cost drug tier and waive deductibles. In January 2020, Illinois passed legislation capping copays and other out-of-pocket expenses at $100 for each 30-day supply of insulin, regardless of the type and amount of insulin needed. And in 2019, Colorado passed legislation capping out-of-pocket costs at the same amount per 30-day supply. RELATED: 10 Insulin Treatment Mistakes to Avoid
Where U.S. President Trump and Former Vice President Biden Stand on Insulin Pricing
Addressing one federally regulated insurance program, the Trump administration announced a plan to limit out-of-pocket costs for Medicare recipients last month by creating a flat monthly copayment rate of $35 for most types of insulin. Drugmakers can voluntarily participate in the plan. According to Reuters, Eli Lilly and Sanofi stated that they planned to take part in the program, while Novo Nordisk said it was reviewing the details of the program. Meanwhile, former vice president Joe Biden, the presumptive Democratic nominee, has weighed in, too, saying Americans are “getting screwed” on drug prices, including the cost of insulin. Biden’s plan to address drug prices would build on the Affordable Care Act and:
Allow Medicare to negotiate with drugmakers to lower prescription drug pricesLimit price increases for all brand, biotech, and “abusively priced” generic drugs to the rate of inflationAllow patients to import prescription drugs from other countriesAccelerate the development of safe generic drugs
RELATED: What to Do if Your Insurance Provider Changes Your Diabetes Treatment Coverage
Drugmaker Lilly Sets Insulin Copay at $35 During COVID-19 Pandemic
The COVID-19 pandemic spurred one drugmaker to set a fixed copay on its products for now, and extend that to people who are uninsured. On April 7, Lilly introduced the Lilly Insulin Value Program, which allows users of commercial insurance, as well as those without insurance, to receive the company’s insulin products for a copay of $35 per month. “Too many people in the United States have lost their jobs because of the COVID-19 crisis, and we want to make sure no one goes without their Lilly insulin,” said Mike Mason, the president of Lilly Diabetes, in a released statement. People who are not eligible include those covered by Medicare, Medicare Part D, Medicaid, other government programs, and state patient or pharmaceutical assistance programs. The insulins covered include:
Humalog (insulin lispro)Insulin Lispro InjectionHumalog Mix 50/50Humalog Mix 75/25Insulin Lispro ProtamineInsulin Lispro Injectable Suspension Mix 75/25
For comparison, the average copay for the short-acting insulin Humalog is $20 to $45 for someone covered by insurance, according to GoodRX. Among those who will benefit most from Lilly’s value program are people who do not have insurance and those with high deductible plans. If someone is taking more than one insulin product, they will pay a separate $35 copay for each, the company told the blog for the diabetes nonprofit Beyond Type 1. The copay will count toward an insured person’s deductible. The program will last at least until the end of 2020, according to the blog. A separate Lilly copay card provides Humulin R U-500 (insulin human injection, 500 units per milliliter) at $25 per month. Those with current copay cards will have the amount adjusted automatically. Those who want to obtain a card are directed to call the company’s Diabetes Solution Center at 833-808-1234, 8 a.m. to 8 p.m. Eastern time on weekdays. RELATED: 9 Diabetes Care Tips During the COVID-19 Pandemic
Cigna and Express Scripts Cap Insulin Copay at $25
Cigna and its pharmacy benefit manager unit Express Scripts announced on April 3 that people in participating nongovernment-funded plans would pay no more than $25 for a 30-day supply of insulin. In a statement, Steve Miller, MD, the executive vice president and chief clinical officer for Cigna, said: “For people with diabetes, insulin can be as essential as air. We need to ensure these individuals feel secure in their ability to afford every fill so they don’t miss one dose, which can be dangerous for their health.”
Additional U.S. States May Be Enacting Insulin Price Caps
Among the states with legislation in the works are: Connecticut A bill capping out-of-pocket insulin costs at $50 per month and the cost of insulin-related supplies, such as syringes, pumps and glucose meters at $100 a month is headed to the bicameral General Assembly for debate. Florida A state house bill is predicted not to pass this year, according to the Tampa Bay Times. Kentucky A bill to limit out-of-pocket insulin costs to $100 per month passed the state house and has Governor Andy Beshear’s support. Tennessee Multiple bills introduced in the state would limit out-of-pocket insulin costs to $100 per month. Among those advocating for more states to pass legislation that would bring cost-relief to people who depend on insulin is the ADA. “We are very hopeful for the passage of this legislation that makes insulin more affordable for many with diabetes,” the ADA said in March. For more on the real-world impact of insulin costs, check out Diabetes Daily’s article “Thrivable Study Sounds the Alarm on Insulin Access in the U.S.”!
