Insulin price-cap measure advances
Questions remain about implementation of plan
HARTFORD — A bill that would create the lowest price cap on insulin and supplies for diabetics in the country is politically difficult for lawmakers to publicly oppose, as it wends through the General Assembly.
But could be hard to implement in a practical sense. And it might only impact a small percentage of diabetics.
Even insurance companies — who would end up picking up a bigger tab for the drug — testified at least partly in favor of the bill, which would, supporters say, save lives by providing diabetics with greater access to medication and supplies.
The bill is headed to to floor of the General Assembly with nearly unanimous bipartisan support from the insurance and real estate committee and many see it as a sweeping change.
Insurers, however, say it won’t lower the underlying, sky-high cost of the drug, which is set by three main pharmaceutical companies that make insulin. Others have quietly raised concerns about funding and logistics for a portion of the bill that would create an emergency access program.
Additionally, the legislation would only apply to the so-called fully-insured market — roughly 32 percent of people insured in the state — and it is unknown how many diabetics are covered by fully-insured plans or other plans. As a result it is unclear how many people would actually be affected by the new law.
“We have to work out some of the language on how the emergency provision would work,” said state Sen. Matt Lesser, D-Middletown, co-chair of the committee. “I think that will come together, but we have to work on tightening up the definitions for the cap.”
If the bill to cap insulin alone passes in its current form, patients would pay $50 for each 30-day supply of insulin, $50 per month for prescribed non-insulin drugs, and $100 for a month of necessary supplies. Connecticut would be the third state to introduce such a cap, following Colorado and Illinois.
Even with some details yet to be determined, Kristen Whitney Daniels, a Shelton woman who has diabetes and leads the Connecticut Insulin4All chapter, said it is heartening to see broad bipartisan support
for the bill and that she’s looking forward to working with legislators to improve some of the language.
She added that the bill might not go far enough, and that she’d like to see it expanded to include help for people who are uninsured or under-insured.
“For me it’s been a really emotional experience to go from rationing insulin to being able to work on this at the state level,” she said. “I’m just really looking forward to making sure no one else has to go through that.”
‘Insurance solution to a pricing problem’
The law could be life-changing for some diabetics as the price of a month’s supply has tripled in the last 15 years by some conservative estimates — costing upward of $1,200 a month in some cases — causing stress and uncertainty for patients and families trying to pay for the drug they can’t live without.
But the legislation is written so that insurance companies would pick up the difference in the bill. Without other mechanisms, the underlying cost of the drug set by the pharmaceutical companies that produce it would remain high.
The Connecticut Association of Health Plans, which represents insurers in the state, offered testimony saying insurers could work toward the goals of the bill, but cautioned lawmakers not to lose sight of the underlying problem of high cost.
“Until unit prices are addressed, the aggressive charge tactics employed by drug manufacturers will continue to be borne by consumers one way or another — either by virtue of increased co-pays or by increased premiums,” the association wrote in submitted testimony. “Capping co-pays is simply an insurance solution to a pricing problem.”
Some insurers, like Cigna, and its pharmacy, Express Scripts, have already voluntarily capped the cost of insulin at $25 per month for people across the country, a move the association expects other insurers will make on their own without a mandate. The mandate, they fear, could set a precedent for future regulations on insurers.
Hard to oppose
Legislators on the committee are also pushing a broader bill that would cap the monthly cost of all prescription drugs at $250 per month for the people with fully insured health plans. That bill would also ban a practice known as “pay to delay,” which pharmaceutical companies use to delay the introduction of cheaper, generic drugs into the market.
The Connecticut Association of Health Plans testified in opposition of that bill, saying, “While we appreciate the intent of the legislation, we can’t support initiatives that seek to implement insurance solutions to pricing problems.”
The difference, a person familiar with the testimony on both bills said, is that insulin is a life or death drug that can make a difference in a matter of hours. In other words, it’s difficult to publicly oppose a bill to provide a single drug that saves lives, in part because people do believe diabetics should have affordable access to insulin. They simply disagree on who should pay for it.
Diabetes is a condition in which the pancreas does not naturally produce insulin, which regulates blood sugar. The absence of insulin leads to diabetic ketoacidosis, which can result in death. Few other illnesses, if any, are so timesensitively dependent on a single medication.
State Sen. Kevin Kelly, RStratford, the ranking Republican on he committee, helped draft the bill to cap insulin costs and said it could actually save insurers money in the long run. Diabetics who experience constant spikes and falls in blood sugar levels often experience other health problems, like kidney, eye and nerve damage, as well as heart disease, among other things, outcomes that also require costly treatments but can be mitigated with consistent blood sugar regulation.
“I think this is a good piece of legislation that’s going to help both individuals and families get the insulin that they need, and that’s gong to have more positive health outcomes, which will help lower the cost across the entire healthcare environment,” said
Kelly said prescription drug benchmarking, another initiative the legislature has taken on, could create more transparency on insulin pricing that could help quell the rising costs.
Creating emergency access
Lesser, the co-chairman, said the logistics of emergency access, the inclusion of supplies, including people on health plans purchased through the healthcare exchange, and helping more people access insulin through qualified community health centers that can offer insulin at a lower rate are all pieces subject to change as the bill undergoes further discussion.
Concerns also remain over a portion of the bill that would create an emergency access program for diabetics who find themselves without insulin before their prescription is due for a refill. Diabetics cannot wait even hours for insulin, which regulates blood sugar, without risking serious health complications.
The bill would would require pharmacists to immediately dispense prescription insulin or equipment to an individual even without a valid prescription if the pharmacist, in their professional judgment, determines that person would suffer immediate physical harm without it.
Funding for that program, along with a provision that would help low-income individuals access insulin and supplies, is still being worked out, as are the logistics of how that would work in a practical sense.
The state operates a prescription drug monitoring program, which allows pharmacists across the state to access prescription information for patients regardless of their home pharmacy. But insulin is not included in that database, according to the state Department of Consumer Protection.
Expanding the database to include insulin would require additional funding and support, which is not explicitly included in the bill.
“We’re looking at some funding sources, potentially some private donation,” Lesser said. “We may be able to set up a really robust safety net to do what we set out to do, which is make sure that nobody in Connecticut dies because they don’t have access to insulin.”