In May 2019, Colorado became the first state in the U.S. to pass a law capping insulin prices for people with insurance (meaning that the cap does not apply to those without insurance). Across the United States, skyrocketing insulin costs have led to as many as 26% of patients on insulin rationing their doses. This law is an important first step to ensure all individuals have access to insulin.
With Governor Polis’ declaration that “the days of insulin price gouging are over in Colorado,” news outlets across the country published stories with headlines about the $100 price cap, patients lauded Colorado’s big step forward, and lawmakers from other states voiced interest in following suit. This bill was a victory for Colorado #insulin4all advocates. But with every victory, it is necessary to look beyond the headlines and explore the small print.
One key point that did not typically come across in the headlines was that this law does not cover all patients. The Colorado bill only caps insulin costs at $100 per month for patients with health insurance. Patients without insurance will not benefit from this law, which is an important factor to consider given that many of the patient deaths that we have seen from insulin rationing in the diabetes community have occurred when patients did not have health insurance.
Another important factor is that this law is not applicable under all forms of insurance. Plans that are subject to federal regulation may be ineligible for this price cap, such as self-funded employer plans that are regulated under federal ERISA rules and the health insurance plans offered to the armed services (TRICARE), and Medicare. Additionally, this bill will not help those in other states. If you are insured in the state of Nebraska, for example, and cross state lines to purchase insulin, your insulin would not be capped at $100. In reality, this bill will not cover all insured Coloradans, nor will it help those coming from other states to buy insulin in Colorado. While it is a step forward, it is not enough for people with diabetes.
It is also important to note that this law does not lower insulin list prices or hold pharmaceutical companies accountable. Instead, for those who have insurance, any costs per month over $100 for insulin would be pushed onto insurance companies. In the long run, this could cause premiums to increase for everyone covered by these insurance plans.
Portraying this law as a “win” is not incorrect. However, many are portraying it as a solution to the insulin price crisis. Unfortunately it is not that simple because it clearly has many limitations. Still, patient advocates fought hard for Colorado to get this legislation right and it can serve as a foundation to build upon.
If your state is working on similar legislation, consider how your bill can hold pharmaceutical companies accountable and how a bill like this may be extended to cover the needs of the uninsured. You can also advocate for adding language on price transparency like the law passed in Nevada in 2017 and contact your Representatives and Senators in Congress to focus on regulating insulin prices for those on federal programs. Keep fighting to make access to insulin a reality for all, including decreasing list prices and holding the pharmaceutical industry accountable for high price.
Insulin price capping legislation has the potential to help millions of patients in the United States, but we can keep working to make sure there is stronger legislation on the state and federal levels to help all patients in need of insulin.
More Info: Estimating the number of people with diabetes impacted by the insulin co-pay cap bills - data from Hannah Crabtree