Your Vote Matters: All About State-Based Insulin Price Cap Laws
The 2020 United States election is rapidly approaching and with it, questions about a COVID vaccine, economic recovery, climate change, systemic racism and the state of our healthcare system are looming, among many others. In the mix is state-led legislation on price caps for insulin. While you won’t see anything specific to insulin-pricing on your ballot, you will see people to vote for—locally and nationally—who will impact the continued conversation on the price of insulin. Before you head to the polls or drop your ballot off in these final weeks, know your role as an advocate and where you stand.
It’s not just the presidential election that counts, but your votes in local and state elections. As the season unfolds, here’s what you should know about the current state of insulin price caps across the United States so that you can make the most informed decisions when voting this year and be an advocate for the issues you care about.
U.S. states with existing insulin price caps
Within the US system, advocates and politicians alike have found more success at passing insulin-pricing bills into law at the state level than at the federal level. This strategy aims to create a groundswell at a state level, hopefully setting a precedent for a national price cap policy.
Since January 2020, ten states have implemented or passed various versions of insulin price cap legislation. Most of these price caps only apply to residents with certain kinds of private health insurance and each applies to those with healthcare plans renewed on or after January 1, 2021.
Very important to note is that NOT all private health insurance plans will be required to institute these price caps. These laws only apply to specific kinds of single-state healthcare plans, meaning if you work for a national or multi-state company that covers employees in multiple states, these single state price cap laws will not apply to you. Similarly, even if your company only operates in a single state, if they have created a self-funded healthcare plan, these price cap laws do not apply either. There are a lot of loopholes, but state-based price cap laws are still seen as a potential first step.
Colorado was the first state to pass an insulin price-cap bill, with a $100 monthly out-of-pocket copay maximum for those with insurance. Illinois, New York, Washington and West Virginia’s legislation also caps out-of-pocket costs at $100 per month. Virginia caps out-of-pocket costs at $50 per month, Maine and Minnesota at $35, Utah at $30 and New Mexico at $25.
In Minnesota, where a price cap bill was signed into law in April, waves were made when pharmaceutical trade association PhRMA filed a lawsuit against the state to block the emergency access portion of the price cap legislation, which the state’s attorney general then struck down. In Tennessee, where price cap legislation has not yet been passed, the original proposed bill would cap out-of-pocket costs for insulin at $100 regardless of insurance coverage, but lobbying groups have approached legislators to constrict the price cap to those with commercial insurance.
Additional state-based insulin price cap bills are championed by local advocates and many have made their way onto Change.org’s Affordable Insulin movement page, which features more than one million signatures across 34 insulin-focused petitions. Official legislation is being discussed in more than 30 other states.
Will any other laws impact insulin costs?
For seniors on Medicare, yes! Starting January 1, 2021, the Medicare Part D Senior Savings Model will kick in, capping some seniors’ monthly insulin copay at $35 per month. The program is opt-in and primarily applies to those who take insulin using pens or needles (insulin taken via insulin pumps is covered under Medicare Part B)—those who would like to be covered by a policy with the Savings Model in place will be able to select an eligible plan during Medicare Open Enrollment, October 15 – December 7, 2020.
For those not on Medicare, questions remain. The President signed four drug-pricing related Executive Orders in July that, while creating attention in the media, are not seen as likely to create any immediate or actionable change to insulin prices. Executive Orders involving regulatory change do not go into effect immediately. The signing of these bills means that the administration now needs to go through the regulatory process of reforming the current system to implement these orders. That is unlikely to happen before November’s election, and if any of the policies are enacted during this term, they would likely face court challenges as well.
How far away are we from a national insulin price cap?
The real answer? It’s hard to say. Whether or not insulin pricing will be approached at the federal level in an actionable way is dependent on who is in office in 2021, not only at a presidential level but across Congress and state legislature. But with many states working to cap the price of insulin, insulin price cap petitioners and advocates across the country have a clear goal in mind: get America on board.
Meanwhile, while broad systemic change is vital, insulin manufacturers have instituted a variety of stop-gap cost savings programs for people who rely on insulin. Each offers low- or no-cost insulin programs to people who earn less than 400 percent of the federal poverty rate (currently $51,040 for an individual or $104,800 for a family of four) as well as copay cards for those who do not qualify for other patient assistance programs.
Who should I vote for?
Time to do your research and make that decision, as well as a plan for how you’re going to vote as an informed voter. Spend the time researching the candidates you’re interested in. Make careful decisions. Take the time to vote. Drop off mail-in ballots ahead of time so that you have no trouble making the impact you seek to make.
Ready to cast your vote? Make a plan to vote with this guide to voting for the diabetes community + read up on the power of the diabetes vote. Use #DropTheVote on social to share your voting stories and why voting is important to you and your family, especially as people impacted by diabetes.
