Seven states have moved this year to cap out-of-pocket expenses for diabetic patients’ insulin, a trend that should help a small group of people who generally are uninsured or have high-deductible plans and have struggled to afford their medication. But it is unlikely to expand beyond insulin or impact health plans’ bottom lines, industry observers say.
The states that have enacted insulin legislation this year — Colorado, Maine, New Mexico, New York, Utah, Washington and West Virginia — generally cap out-of-pocket costs for some or most patients at $100 per month. Those new state laws join insulin copay legislation already on the books in eight other states, including Alabama, Delaware, Kentucky, New Hampshire, Oklahoma, Oregon, Rhode Island, Texas and Virginia, according to a report from the National Conference of State Legislatures (NCSL).
Jeff Myers, senior vice president of market access and reimbursement strategies at Catalyst Healthcare Consulting, Inc., says he doesn’t expect insulin copay caps to cost health plans a significant amount of money. However, the funds have to come from somewhere, because the states by themselves can’t force the price of insulin down.