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Save Lives by Capping the Out-of-Control Cost of Insulin

One hundred million Americans are at elevated risk of being required to use insulin, including 7 million who rely on daily doses to stay alive. Their life is in danger not just from their disease, but from the exploitative drug companies that make this life-saving drug unaffordable. Nearly a quarter of all insulin-dependent diabetics now skimp on doses due to cost. Yet the tripling of cost in the last decade is attributable almost entirely to the three large pharmaceutical companies that control 90% of the U.S. market. A carton of insulin that sells for $300 in the U.S. can be purchased in Canada for $20! Capping the monthly cost of insulin ensures that millions of Americans can afford a medicine that they cannot live without....

Frequently Asked Questions
Who does this help?
An insulin price cap helps the hundreds of thousands of state residents who use insulin on a daily basis and their families.
Is this high cost for the state government?
This has no cost impact on the state, and instead is likely to reduce healthcare costs overall by ensuring people with diabetes receive the care they need to prevent significant health threats and death.
Are there alternative solutions for reducing the cost of insulin?
A standard solution for driving down the price of drugs in the United States -- competition via generics once a medication comes off patent -- has not proven workable for the insulin market. The pharmaceutical companies that dominate the market have continually made minor changes to their products to update their patents, imposing an ongoing barrier to lower-priced alternatives. Since drug prices in the U.S. are not regulated by the federal government, states must step up to protect consumers.
Partners
  • Families impacted by diabetes
  • Patient and consumer advocates
  • Healthcare providers
Opposition
  • Pharmaceutical companies and pharmacy benefit managers profiting off of the high price of insulin
Model Policy
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SECTION 1 (TITLE):
This act shall be known as the Insulin Cost Reduction Act
SECTION 2 (PURPOSE):
To reduce the cost of insulin for diabetics who are insured through commercial insurers by limiting their monthly cost sharing payments to reasonable amount.
SECTION 3 (PROVISIONS):

(a) Every health plan offered by a carrier shall set the cost-sharing payment that a covered person is required to pay for a covered prescription insulin drug at an amount that does not exceed $30 per 30-day supply of the prescription insulin drug, regardless of the amount or type of insulin needed to fill the covered person’s prescription.
(b) Nothing in this section shall prevent a carrier from setting a covered person’s cost-sharing payment for a covered prescription insulin drug at an amount that is less than the maximum amount permitted pursuant to subsection (a).
(c) No provider contract between a carrier or its pharmacy benefits manager and a pharmacy or its contracting agent shall contain a provision
-(i) authorizing the carrier’s pharmacy benefits manager or the pharmacy to charge,
-(ii) requiring the pharmacy to collect, or
-(iii) requiring a covered person to make a cost-sharing payment for a covered prescription insulin drug in an amount that exceeds the amount of the cost-sharing payment for the covered prescription insulin drug established by the carrier pursuant to subsection (b).