By Ana B. Ibarra, CalMatters
As many diabetics across the Golden State struggle with insulin costs, California’s efforts to make the medication more affordable have yet to yield results. This year, lawmakers will revisit legislation that would address at least one piece of the affordability puzzle.
Senate Bill 90, by Sen. Scott Wiener, a San Francisco Democrat, would limit what diabetics pay out of pocket for their insulin — prohibiting state-regulated health insurance plans from imposing a deductible on those prescriptions and capping the copay at $35 for a 30-day supply. The current copay limit is $250.
The bill, advocates say, is meant to provide some immediate relief to consumers as the state works on a more ambitious plan to develop its own low-cost insulin. That’s expected to take at least two to three years.
California legislators have tried passing cost-sharing caps in the past without success. Last session’s bill, carried by former Republican Sen. Patricia Bates of Laguna Niguel, died in an Assembly committee. Despite bipartisan support, the insurance industry pushed back, arguing that capping costs only on the consumer’s end does little to tackle the underlying issue: the list price of insulin.
“I would never suggest that the only problem is copays; overall cost is also a problem,” Wiener said. “We absolutely need to limit what consumers are paying out of pocket at the same time that we do this other structural work around the cost of insulin.”
Twenty-two states and the District of Columbia have enacted caps on copays, ranging from $25 to $100 a month, said Dr. Francisco Prieto, a family physician and advocacy chair for the American Diabetes Association, which is sponsoring Wiener’s bill.
“We are the largest state in the union, so we are also the largest target,” for the opposition, Prieto said. “We have not been able to get this through, but I fully expect that we will, hopefully this year.”
In California, an estimated 3.2 million people are diabetic, and many of them rely on insulin. An analysis for last year’s similar copay cap bill estimated that there are about 118,000 diabetics with insurance plans that would be subject to the state cap.
Last year, Congress passed a cap of $35 a month for diabetics covered by Medicare, the federal insurance program for seniors and people with disabilities, but abandoned a similar effort for people covered by private insurance. That law went into effect on Jan. 1, and in California it is expected to benefit about 108,000 people. Each patient is expected to save about $339 a year, according to the U.S. Department of Health and Human Services.
The burden of insulin costs has a long history — stories about people rationing their medication and relying on the emergency room for their uncontrolled diabetes are common throughout the country. A recent national survey found that approximately 16.5% of insulin users ration their medication, usually by delaying the purchase of it. Rationing insulin leads to poor control of diabetes and is linked to increased instances of strokes, heart failure and kidney failure.
Compared to other countries, the U.S. is known to have the highest price tags for insulin — an average of $98.70 per vial, compared to $12 a vial in Canada, according to a 2020 analysis by the Rand Corporation, a public policy think tank. People usually need two to three vials a month, and some may need more. What people pay at the counter depends on their insurance coverage. People without insurance are on the hook for the full cost.
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