Colorado legislators are considering a bill to fix a hole in the state’s first-in-the-nation cap on insulin prices and to create a new program for people left out by that cap.
House Bill 1307 clarifies that the $100 cap applies to all insulin prescriptions. A previous bill limited copays, but didn’t specify that patients couldn’t be charged separately for each prescription, meaning some people who need multiple types of insulin continued to pay more.
The $100 cap only applies to commercial health insurance plans regulated by the state’s Division of Insurance. That means if your employer offers an insurance plan based in another state, or takes on the risk of insuring employees itself, there’s no limit on how much you could pay out-of-pocket for insulin.
The bill also would create a program allowing people who aren’t covered by the $100 cap to get one emergency 30-day supply of insulin each year for $35, and to join a program providing insulin for a full year for $50 per month.
“We wanted a way for folks to have access to an emergency supply because of the dire nature of running out of insulin. Then, they’ll have the option to enroll in an ongoing program for a slightly higher price once the emergency period has passed,” said Rep. Dylan Roberts, a Democrat representing Eagle and Routt counties, who is the bill’s main sponsor.
The price of a vial of insulin, before any discounts, has risen from about $20 in 1990 to more than $300 today, Roberts said. The first medical insulin was created 100 years ago, and while there have been some improvements since then, they don’t justify increases far above the rate of inflation for a drug that people with diabetes need to survive, he said.
“For them, it’s like oxygen,” he said.
The bill passed the House, 45 to 19, with one representative excused. It passed out of committee in the Senate on Thursday, and has a good chance of passing before the end of the session, said Senate Majority Leader Stephen Fenberg, a Boulder Democrat.
If the bill passes the Senate and Gov. Jared Polis signs it, the new insulin program would start Jan. 1. People covered by insurance plans subject to the $100 cap, Medicare, or Medicaid aren’t eligible. The emergency supply would only be available to people who have less than a seven-day supply of insulin left.
Insulin manufacturers would have to reimburse pharmacies for the difference between the wholesale cost of any insulin they distributed through the program and the $50 copay, or provide the same amount of insulin. The rule doesn’t apply if the loss is less than $24, which is the estimated cost to produce and ship a three-milliliter vial of insulin, Roberts said.
Brian Warren, director of government affairs for the Biotechnology Innovation Organization, a trade group that includes pharmaceutical companies, said the bill ignores recommendations that would do more to lower insulin prices, and is illegal under the Fifth Amendment, because it would require companies to give away their product.
The Fifth Amendment forbids taking private property without compensation, among other things. Roberts said a similar program in Minnesota survived a court challenge.
Warren, who was the only witness testifying against the bill in a committee hearing on May 19, said pharmaceutical companies already provide assistance to patients who would pay the “sticker price” for insulin, and that most patients pay a discounted rate.
“There’s the list price for insulin… then there’s the actual price paid,” he said.
Gail deVore, who has Type 1 diabetes and has spoken in favor of previous bills to limit insulin costs, countered that patient assistance programs aren’t reliable enough for a medication that patients need to survive. She said she once went into a coma after going 12 hours without insulin, and significant numbers of Coloradans put their health at risk by rationing insulin when they can’t afford another bottle, which can cost $300 or more.
“Those manufacturers’ programs are not consistent, and they’re not guaranteed month to month,” she said.
Rep. Mark Baisley, a Republican representing Douglas and Teller counties, asked whether the bill could lead pharmaceutical companies to stop selling insulin in Colorado. Christine Fallabel, mountain region director of state government affairs for the American Diabetes Association, said pharmaceutical supply chains aren’t set up to cut out states.
Baisley and several other Republicans said they were reluctant to support more government intervention, but the market hasn’t produced affordable insulin prices.
“It’s an awkward solution to an awkwarder problem,” Baisley said.
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