Insulin Cost Cap Act
Written By Richard DeShay Elliott
This bill will require insurance carriers that provide coverage for prescription insulin drugs to cap the total amount that a person with the aforementioned insurance coverage is required to pay at an amount not to exceed $25 per 30-day supply of insulin, regardless of the amount or type of insulin needed to fill the covered person’s prescription. Insurance companies will cover the costs of insulin above the $25 co-pay threshold.
The Maryland Prescription Drug Affordability Board, implemented in 2019, will set and enforce this cost cap. This cap will apply to all health care plans signed or extended on or after July 1st of the year that this bill passes. Furthermore, this bill will allow up to a 30-month supply of insulin be provided at a cost of $25 to those without healthcare insurance.
Any costs assumed by the state to fund insulin for state/local employees or to ensure adequate staffing and responsiveness from state agencies, alongside other implementation and quality control costs regarding this program, will be funded via a .01% tax on Maryland-based corporations with a post-taxation profit of over $10,000,000.
BACKGROUND
Here in Maryland an estimated 623,000 people, or 12.6% of the population, now have diabetes. Of these, 156,000 of them have diabetes and simply do not know it. In addition, 1,634,000 people in Maryland or a staggering 36.9% of the population, have prediabetes[1]. Per the Colorado insulin bills fiscal note, approximately 15% (93,450 people) are presumed to be insulin dependent.
Diabetes is the nation’s seventh-leading cause of death, accounting for more than 79,500 deaths annually. It also contributes to deaths from heart disease and stroke which are the leading and fifth-leading causes of death, respectively. There are three major types of diabetes: type 1, type 2, and gestational. Type 2 diabetes accounts for 90 to 95 percent of all cases.
Diabetes is a leading cause of kidney failure, nontraumatic lower-limb amputations and blindness among adults. In 2016, 14.0 percent of Americans were estimated to have diabetes, 69.3 percent of which were diagnosed and an estimated 30.7 percent of which were undiagnosed. In 2015, 1.5 million new cases of diabetes were diagnosed among adults aged 18 and older.
National direct medical costs and lost productivity attributable to diagnosed diabetes is estimated to be $327 billion each year — accounting for one in seven dollars spent on health care. Among people with diagnosed diabetes, direct medical costs are twice as high compared with people without diabetes after adjusting for population age and sex differences.
As NPR reported, an uninsured Minnesota man who couldn't afford to pay for $1,300 worth of diabetes supplies, died of diabetic ketoacidosis, according to his mother. The man, who was 26, had been rationing his insulin. Diabetic ketoacidosis, limb amputations, as well as other life-threatening complications of diabetes are preventable. However, the ever-increasing cost of insulin has led to patient rationing which has resulted in an increased number of these preventable complications flooding our Maryland Emergency Departments.
https://leg.colorado.gov/bills/hb19-1216
Prescription insulin drugs - 30-day supply - cost-sharing cap - appropriation. Effective January 1, 2020, the act caps the cost sharing a covered person is required to pay for prescription insulin drugs at $100 per 30-day supply of insulin.
The act requires the department of law to investigate the pricing of prescription insulin drugs and submit a report of its findings to the governor, the commissioner of insurance, and the judiciary committees of the senate and house of representatives.
$26,054 is appropriated to the department of regulatory agencies for use by the division of insurance to implement the act.
https://leg.colorado.gov/sites/default/files/documents/2019A/bills/fn/2019a_hb1216_f1.pdf
This bill requires insurance carriers that provide coverage for prescription insulin drugs to cap the total amount that a covered person is required to pay at an amount not to exceed $100 per 30-day supply of insulin, regardless of the amount or type of insulin needed to fill the covered person's prescription. The bill will increase state expenditures and General Fund diversions on an ongoing basis.