Colorado lawmakers to look at reducing insulin costs for people not covered by price cap
Colorado lawmakers likely will take up the cost of insulin again in January in an effort to patch cracks in the state’s first-in-the-nation cap on what patients pay.
Rep. Dylan Roberts, a Democrat representing Eagle and Routt counties, said he plans to introduce a bill allowing members of the public to buy insulin at the rate the state pays for its employees. Interested lawmakers are still discussing who would be eligible, he said, though he hopes it includes people with high-deductible plans as well as those without insurance.
“The goal is to have it applicable to as many people as possible,” he said.
Conor Cahill, spokesman for Gov. Jared Polis, said the governor is interested in continuing to lower drug costs, but would need to review a bill before commenting. A spokeswoman for Senate Democrats said she couldn’t comment on pending bills.
Under Colorado’s 2019 insulin cap, which Roberts also introduced, people with state-regulated insurance plans pay no more than $100 each month for each insulin prescription. The $100 cap doesn’t apply to people with insurance plans regulated by the federal government or another state, or to people who don’t have insurance.
“The co-pay cap was a good first step,” he said. “I think the next step is those with insufficient insurance or no insurance.”
Exactly how the program would work isn’t yet clear, but Utah established a bulk-purchasing plan based on a similar idea earlier this year.
Rep. Norm Thurston, a Provo Republican who sponsored the bill creating the Utah program, said that state’s employee health insurance plan negotiated a roughly 70% discount on the sticker price for several types of insulin. The program allows people who aren’t state employees to buy insulin at the discounted rate, he said.
Say a vial of insulin normally sells for $300, but the state negotiated a $100 rate. A state employee might only have to pay a fraction of that cost — perhaps a $20 copay — because they’ve already paid for insurance, which covers the rest. A person who signed up through the insulin program would pay $100 — more than the state employee, but still significantly less than they would have without the program.
In Utah, the state employee health plan pays the $200 difference to the pharmacy upfront, but gets it back in rebates from the insulin manufacturer, said R. Chet Loftis, managing director of the state’s Public Employees Health Program.
On balance, the state doesn’t pay anything, other than the nominal cost of running the sign-up website and sending prescription cards, Thurston said. Anyone can sign up, though people who have insurance might find it’s cheaper to go through their plan than to use the program, he said. The state-negotiated price ranges from about $45 to $98 per vial.
“Nobody should ever pay more than the state government is paying for insulin,” Thurston said.
Christine Fallabel, mountain region director of state government affairs for the American Diabetes Association, estimated about 10,000 people are covered by Colorado’s copay cap. She said she wasn’t sure how many might be eligible for the proposed group purchasing plan, but about 700 people have signed up for the Utah program since June. The state estimates about 74,000 people in Colorado use insulin.
Gail deVore, who has diabetes and advocates for policies to help patients, said the proposed Colorado program would go a long way toward helping people not covered by the insulin price cap. The challenge would be getting the word out to eligible people, she said.
“This solves the eligibility problem,” she said.
About 40% of people who responded to a survey posted on the Department of Law’s website said they had rationed their insulin because of costs. The survey wasn’t sent to a representative sample of Coloradans, however, so it’s possible that people who were struggling with costs were more likely to seek it out and respond.
A report from the Department of Law attributed the rising price of insulin to a lack of competition among drug companies and to a lack of incentives for middlemen to pass any savings to insurance companies and patients.
An older type of insulin sells for as little as $25, but it doesn’t work well for all people with diabetes, and people who use it have a higher risk of dangerously low blood sugar than those using more modern formulations.
Trying to make due with less insulin increases a person’s risk of emergency room visits in the short term and complications like kidney disease or amputations in the long run, deVore said.
Making insulin cheaper “will reduce those longer-term costs to society,” she said.
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