Bill to cap insulin co-pays in some health plans to $100 per month per prescription moves to full House with 74 sponsors

Charlotte Whittaker, Rep. Danny Bentley and Mary Beth Lacey present HB 12. (Twitter photo by Lawrence Smith, WDRB-TV)

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — A bill to limit the cost-sharing requirements for insulin prescriptions has passed out of committee and is before the full House.

House Bill 12, sponsored by Rep. Danny Bentley, R-Russell, would require state-regulated health-insurance plans to cap a patient’s cost for a 30-day supply of each insulin prescription drug at $100 “regardless of the amount or type of insulin needed to meet the covered person’s insulin needs.” The bill does not include Medicaid, Medicare or self-insured government plans.

Insulin is a hormone that regulates the amount of glucose in the blood, and a lack of it causes diabetes. People with Type I diabetes can’t make any insulin so they must inject it to control their blood sugar — and to stay alive. People with Type II diabetes, which is more common, can produce some insulin, but not enough. Type II is usually treated with diet, exercise and oral medications.

More than one in eight Kentucky adults have been diagnosed with diabetes, according to the 2017 Kentucky Behavioral Risk Factor Survey. In that year, diabetes was the fifth leading cause of death in Kentucky, according to the federal Centers for Disease Control and Prevention.

Bentley, who is a pharmacist with Type I diabetes, said HB 12 is supported by the American Association of Retired Persons, the American Diabetes Association, the Kentucky Medical Association, the Kentucky Pharmacy Association and Insulin4All.

Holding up a $290 box of insulin, Bentley said it’s not uncommon for a person to use up to five boxes a month, which could end up costing about $1,200 monthly without insurance. The woman who loaned him the box said she paid about $300 a month for her monthly supply or about $3,600 a year, with help from insurance. But that does not include all the other supplies and equipment she needs to treat her diabetes, which also comes at a great, ongoing cost.

Bentley said in the last 14 years, the cost of insulin has gone up 550 percent.

In a detailed blog post about how this cap would help many thousands of Kentuckians with diabetes, Dustin Pugel of the Kentucky Center for Economic Policy reports that from 2012 to 2016, insulin prices at point of sale more than doubled in Kentucky, growing from $352 to $721 for a 30-day supply.

He adds that nearly one in three Kentucky adults with health insurance have plans with large cost-sharing requirements, whether it’s in the form of a high deductible, large co-payment or a plan that covers only a fixed percentage of the cost through co-insurance.

The bill passed unanimously out of the House Health and Family Services Committee Feb. 13 with a committee substitute. Including Bentley, the bipartisan bill has 74 sponsors. If passed into law, it would go into effect Jan. 1, 2021.

Charlotte Whittaker, volunteer state president of AARP Kentucky, said older Americans with diabetes are hit especially hard with these growing cost, noting that Medicare Part D enrollees take an average of four to five prescriptions per month, with an annual income of about $26,000.

“Prescription drugs don’t work if you can’t afford them — that’s the bottom line,” she said, later adding, “No Kentuckian should be forced to choose between putting food on the table or buying a lifesaving medication.”

Mary Beth Lacey of the American Diabetes Association reminded the panel that people who need insulin need it to live and to avoid devastating complications, like blindness, kidney failure, lower limb amputation, heart attack, stroke and even death

Lacey, who described herself as a 43-year survivor of Type I diabetes, showed the committee a device that allows her to constantly monitor her insulin level through her cell phone. She stressed that such technology should be available to everyone, but isn’t when people with diabetes are still simply trying to figure out how to pay for their insulin.

“We should not be struggling to stay alive, we should be thriving,” she said, “Without insulin, people with diabetes die, and scaling back on insulin can lead to costly and sometimes deadly complications.”

Research shows that about one in seven adults under 65 diagnosed with diabetes skipped doses, took less of their medicine or delayed filling a prescription to save money. Lacey said research shows that for one in four insulin users say cost has affected their use of it.

Lacey said 1.7 million Kentuckians either have or are at risk of having diabetes. The ADA estimates that the cost of caring for diabetes in Kentucky based on 2017 data was greater than 6.1 billion a year.

“By keeping insulin affordable, we can help keep people with diabetes out of the ER and the hospital and away from expensive and potentially disabling or deadly complications,” she said.

She added that the ADA would like to see a $100 a month collective cap, rather than a $100 per month per prescription cap.

Rep. Robert Goforth, R-East Bernstadt, said he would like to see assistance for people who have no insurance, which Bentley said was not addressed in this bill. Bentley said HB 423, sponsored by Rep. Steve Sheldon, R-Bowling Green, also addresses the cost of insulin and would help the cash customer. He added that House Bills 398399400 and 423 also deal with the price of insulin.

Sheldon, a co-sponsor of HB 12, called it a great first step.

“Drug pricing all across this nation has gotten completely out of hand,” he said. “Until we get away from the way we price all drugs, it’s going to be difficult and insulin is probably the most extreme example.”

The bill’s fiscal note estimates that capping the co-pay for insulin to $100 each month will increase premiums for health plans, excluding Medicaid and the state employee plan, 7 to 24 cents per member per month.

Asked who would absorb this, Sheldon said because insulin prices are so inflated and because so many groups have “their hands in the cookie jar,” the industry “will find a way to eat that 24 cents for sure.”

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