Monthly co-pays for insulin will be capped at $50 on January 1 in Virginia, thanks to HB 66, which the General Assembly passed in Spring of 2020. Politicians from both parties have called for strategies to make insulin more affordable. Delegate Lee Carter (D-Manassas) introduced the bill, initially calling for an even lower co-pay cap of $30 that was later amended to $50.
“From 2007 to 2017, the wholesale price of insulin has tripled, and the handful of pharmaceutical companies manufacturing insulin have reaped profits into the billions of dollars. Though the U.S. market consists of about 15 percent of insulin users globally, reporting suggests about 50 percent of worldwide insulin revenues come from the United States,” Carter’s 2019 press release said. “It’s unconscionable that – while these companies are raking in obscene profits – everyday folks are rationing their insulin, going without, and in the most tragic cases dying.”
Carter’s bill received broad bi-partisan support in the House, receiving only four “nay” votes. However, in the Senate, only three Republicans voted for the bill.
The cap comes as prices for the life-giving drug have skyrocketed — one study in the Journal of the American Medical Association found the mean price of insulin increased by 197 percent from 2002 to 2013. A study by the Health Care Cost Institute showed average insulin sale costs doubled from 2012 to 2016 — from $7.80 per day for an average patient to $15. Even with private insurance, many patients pay up to 20 percent of the cost of their insulin, according to The Commonwealth Fund.
Although insulin was invented nearly a century ago, as pharmaceutical companies develop more effective types of insulin that can be more effectively tailored to individual patients’ needs, costs have risen for both older and newer forms of insulin. According to the American Action Forum, there are three factors driving increased cost: a lack of competition, lower revenues triggered by the American Care Act, and rebate structures that incentivize raising list insulin prices and disincentivize insurers from covering lower-cost insulins.
A 2018 study of rising insulin costs found that 27 percent of insulin users used strategies including missing doses, taking less insulin than prescribed, and switching to lower-cost insulins. “Insulin users for whom cost affected their purchase/use of insulin experience adverse health effects at higher rates than those for whom cost did not affect purchase/use,” the American Diabetics Association found.
However, co-pay caps don’t help uninsured patients and might cause insurance premiums to rise. “Among those under age 65, increasing access to insurance coverage and the generosity of that coverage are the most important steps for increasing access to insulin,” the Commonwealth Fund study states.
President Donald Trump helped introduce a $35 co-pay cap for certain Medicare users that also goes into effect in the new year.
“Americans pay more per capita for prescription drugs than residents of any other developed country in the world. It is unacceptable that Americans pay more for the exact same drugs, often made in the exact same places,” Trump said in an executive order.
A wave of legislation similar to Virginia’s is sweeping across the country — some states have insulin co-pay caps at $100, while others have caps as low as $35.
On Monday, Delegate Michael Mullin (D-Newport News) tweeted, “Shoutout to @carterforva for making Virginia the first in the South to cap the price of insulin. Most important bill of last session nobody was talking about.”
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Eric Burk is a reporter at The Virginia Star and the Star News Digital Network. Email tips to [email protected].
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