Colorado’s insulin cap brings savings for people with diabetes, but some struggle with program
Small number report trouble getting insulin
Colorado’s insulin cost cap can save people with diabetes hundreds of dollars a month, but some patients have reported confusion about how to take advantage of it.
A law passed in 2019 and expanded in 2021 limits the out-of-pocket cost of insulin to $100 per month in stateregulated insurance plans, including those sold on the individual marketplace and some employer-sponsored plans. People whose coverage isn’t state-regulated can fill out an annual application to buy insulin for $50 a month.
In theory, a patient with an insulin prescription can print out the application and bring it to any pharmacy, along with proof they live in Colorado, and receive a month’s supply of the drug. The pharmacy can then seek reimbursement from the insulin manufacturer.
It hasn’t always worked that smoothly.
Melinda Galjour, who moved to Colorado last year, said it’s been a challenge figuring out how to access the state’s insulin program. When she took the application to the pharmacy she normally uses in Silverthorne, they didn’t know what to do with it, leaving her with the prospect of paying $500 out of pocket for a month’s worth of insulin.
Galjour asked the Colorado Department of Regulatory Agencies for help, and they sent a link to share with the pharmacy and suggested she could file a complaint. In the meantime, she was able to get this month’s insulin using a manufacturer’s discount program, but people who are running out of insulin shouldn’t have to make multiple calls and pharmacy visits to get their prescriptions filled, she said.
“It’s not my job to educate and bring a website link to my pharmacy about a state-run program,” she said.
Vince Plymell, spokesman for the Colorado Division of Insurance, said 40 people have sought help or filed complaints about difficulty accessing insulin through the program since January 2022. The state doesn’t track how many people have downloaded the insulin program application or attempted to use it.