Health Care/Joan Retsinas

The States Tackle Insulin Prices

The battle -- COVID versus us -- has pushed all other health crises to the back burners, as it should.

Back burner crises, though, do not vanish.

The spike in insulin prices is one crisis. Thirty-four million Americans have diabetes, and seven million take daily insulin. In 2018 the average annual cost for insulin came to almost $6,000 per patient — increasing 14% annually from 2012 to 2018. Economists have called diabetes the most expensive chronic disease — a grim distinction. The entrepreneurs at drug companies recognized long-acting and rapid-acting insulins as winners, letting them ratchet up prices. At the same time, the combination of pharmacy benefit managers and rebates has skewed demand for the newer products.

Not surprisingly, patients have complained. Even with insurance (Medicare, Medicaid and Children’s Health Insurance pay for 60% of the cost for their enrollees), the co-payments are steep. And 5% of adults ages 26-64 with diabetes have no insurance. One estimate is that one-quarter of patients ration their insulin. They risk diabetic ketoacidosis, which can be fatal.

Even so, pharmaceutical manufacturers have been slow to push prices back enough to matter. They cite the new, quicker-acting insulins on the market. And in spite of the rhetoric of dismay, coupled with congressional hearings, this President and this Congress did not work their magic.

Enter the states. The COVID battle has made generals of the governors. In the absence of clear federal directives, governors have organized testing, overseen the distribution of supplies, decided when and how to open their states.

Many governors have shown the same initiative on the insulin-front. To date, a slew of states have enacted legislation to tamp down costs for hard-hit patients. Colorado (May 2019) was the first, followed by Illinois and New Mexico. There is no one template. Some states focus on the uninsured, as well as those with exorbitant co-pays. Others focus only on enrollees in plans overseen by the state. The states include Connecticut, Delaware, Hawaii, Kentucky, Massachusetts, New Jersey, New York, Ohio, Oregon, Pennsylvania, Utah, Virginia, Washington, West Virginia.

The latest activist-state is Minnesota. The Alec Smith Insulin Affordability Act (April 2020) is named for 26 year-old Alec Smith, who died of diabetic ketoacidosis when he rationed his $1,300 a month insulin. The Act proposes to push back the co-pay to no more than $50 for a 90-day supply, under a manufacturer’s patient assistance program, for people with incomes below a set level.

Faced with publicity, some drug companies have responded. Eli Lilly for instance, halved the price of two insulin drugs. CVS Health, Cigna Health, Express Scripts and Medicare have offered easements.

From one vantage, this is a success tale: States wrested their powers to bring down the price of insulin for residents eligible for help.

From another vantage, this is a tale of federal failure. States are not the solution for abrupt spikes in any one drug. We Americans take a pharmacopeia of medications; we cannot expect states to oversee any and all price-increases. A patient’s access to “affordable” insulin, or any other medication, should not depend upon the willingness of a particular state to fight this battle. With that approach, “state of residence” will determine a patient’s cost.

COVID has left states charged with maintaining the public’s health — a Herculean task made more Herculean at a time of shrinking tax revenues. The price of insulin will not make it to every governor’s agenda.

Ultimately we need federal action. With this, as with the virus, we need an intelligent, focused Uncle Sam to take charge.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, June 15, 2020

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