The Other Side of the Colorado Success

By now, you know that Colorado’s governor signed a bill into law this week capping insulin co-pays at $100 per month. Great news, right? It really is, I guess. But I’m still left with some questions.

The most obvious question surrounds Colorado as the only state to enact such a law. What about the other states? What if other states pass similar measures, but the co-pay number is different in each state?

Colorado caps co-pays at $100 per month. Let’s say neighboring Wyoming decides to cap it at $40… if you live in Denver, would you drive a few hours to pay $60 less per month for insulin if you could? How many other locales might be affected by such a scenario? Might people from Wyoming drive now into Colorado to try to save on insulin? Is that how we want to do this?

Actually, my state of Maryland had a Senate bill introduced in the last session that would have eliminated nearly all co-pays for both insulin and test strips. It didn’t make it to passage, but it was in the same vein as the Colorado bill and in fact, would have gone quite a bit farther.

Should it have passed, I’m sure that a family or two might have considered moving from southern Pennsylvania or Delaware, or even Virginia or West Virginia into the Old Line State (I have no idea why Maryland is called that). Insulin is that expensive.

So I’m concerned about a state-by-state approach to insulin access issues.

I would rather see our federal government, fractured as it is right now, come together on legislation that would really move the needle on this issue. Like eliminating co-pays for all patients requiring insulin and test strips.

And while we’re at it, how about eliminating co-pays for drugs required to treat HIV, or serious allergies, or any number of additional conditions? Basically, if it keeps you alive, no co-pay.

I don’t think that’s too much to ask for. It’s part of why I’ve been to Capitol Hill twice in the last eight months to lobby lawmakers.

I’m happy that Colorado has taken steps to address this issue. Now it’s time for our federal government to make positive progress to address access to affordable insulin, guaranteeing it with federal legislation.

I think that’s something all of us can live with.

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  • Rick Phillips  On May 24, 2019 at 10:26 pm

    I think there are two main issues that this presents.

    First, we have to understand that for every provision like this, there will be higher insurance rates for everyone. Nor will this be strictly a dollar for dollar increase. In fact what will usually occur is that each dollar charged will increase insurance rates by between $3.00 and $4.00. Some of that is greed, but the breakdown will be more nuanced. Yes some of the increase is profit, but other parts are administrative fees, and the what is called reserve. Reserve is likely the most misunderstood part of insurance rates. Remember, insurance companies must cushion the expense for cost increases, and more utilization. One can make the argument that a cost of insulin dollar means more to people than the cost of an insurance dollar, since the insurance dollar is paid by everyone, but for those living at the margin, cost is the issue no matter who charges it.

    The second thing is that this action will add fuel to the fire of the proposals relating to offering insurance plans across state lines. These proposals work like this. Lets take state or territory x. They may chose for a variety of reasons to set minimum standards at the lowest legal level. Once a plan is allowed to sell in state or territory x then they can sell that plan in every area. This will of course lower the cost of insurance, but it will not enhance coverage. Since many who buy insurance will naturally want to pay the lowest cost (most), state or territory x will be the de facto minimum standard. Making a win like CO meaningless.

    We must understand a fundamental truth, there is no free lunch in insurance. In fact there is a a more important truth as well. Insulin pricing is not solely a manufacturer, PBM, government, insurance, employer or insulin user issue, it is all of our issue. To solve the problem we cannot attack one slim part of the pie, we have to attack it all. In my opinion the CO law is pushing on one side of the circle when instead we must push on all sides. Pushing only one side of the circle means shifts the burden elsewhere and in the end, it will be the end user who will suffer.

    Liked by 1 person

    • StephenS  On May 24, 2019 at 11:28 pm

      Rick, you make several great points. In the end, I feel like the circle will be pushed on all sides, by several different little things. I hope that happens soon.


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