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

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

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






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.

Charlotte Whittaker, Rep. Danny Bentley and Mary Beth Lacey
 present HB 12. (Twitter photo by Lawrence Smith, WDRB-TV)  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,...
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Bill to cap insulin co-pays in some health plans to $100 per month per prescription moves to full House with 74 sponsors Bill to cap insulin co-pays in some health plans to $100 per month per prescription moves to full House with 74 sponsors

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News source: Kentucky Health News
Publication date: 15-02-2020 16:03
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