Policymakers are Prioritizing Diabetes Management Given Soaring Insulin Prices

September 12, 2019|10:58 a.m.| ASTHO Staff

Over 30 million Americans live with diabetes, and diabetes accounts for $330 billion in healthcare spending annually. Diabetes is the seventh leading cause of death in the United States and number one cause of kidney failure and adult blindness. All fifty states and the District of Columbia offer chronic disease prevention and management programs, including those that utilize evidence-based lifestyle change programs and build community-clinical connections.

Diabetes is a priority area for 14 states within their state health improvement plans; including Arkansas, Arizona, California, Colorado, Connecticut, Georgia, Iowa, Idaho, Maryland, New Hampshire, New Jersey, Rhode Island, Utah, and the District of Columbia. State health agencies are also working across sectors to improve social determinants of health – such as improving access to healthy foods and safe places to exercise –a strategy to reduce the risk of diabetes in the first place. For example, the Illinois Department of Public Health and Texas Department of State Health Services are working with ASTHO to implement place-based approaches and innovative care delivery models to reduce the risk of diabetes.

Of course, individuals living with Type 1 diabetes and some people with Type 2 diabetes require daily insulin injections as part of their treatment. The cost of insulin per patient has nearly doubled between 2012 and 2016 with an average annual cost of $5,705 per patient in 2016. This presents serious concerns about whether Americans with diabetes can afford a medical product critical to their survival. Of particular concern, one in four individuals with diabetes (both those with and without health insurance) have said they have rationed or skipped taking insulin due to cost, which can lead to medical complications and be life-threatening.

In response to insulin price increases, some private insurance companies are independently working to cap out-of-pocket insulin costs for consumers, and a 2019 IRS rule change allows preventive medication and services to be covered to individuals in some high deductible health plans. Individuals without health insurance (13.7 percent of Americans at the end of 2018) would still be responsible for covering the cost of insulin in its entirety.

The federal government has taken several actions that attempt to improve access to and affordability of insulin. First, the Food and Drug Administration announced in April 2019 new policies to increase competition in the insulin market. In July 2019, the U.S. Senate introduced bipartisan legislation that would cut insulin prices up to 75 percent from anticipated 2020 levels.

State legislatures are also moving forward with strategies to ensure that Americans with diabetes can access care and afford the cost of insulin. In May 2019, Colorado enacted H.B. 19-1216, which will cap the co-pay for a 30-day supply of insulin at $100 effective Jan. 1, 2020. The Colorado Department of Law (Office of the Attorney General) has also been required to submit a report to the legislature by November 2020 investigating current pricing practices and recommending whether additional consumer protections are needed. The Florida, Illinois, Michigan, New York, Pennsylvania, Rhode Island, and Wisconsin legislatures introduced similar bills between June-August 2019, each of which would cap the out-of-pocket cost for a 30-day supply of insulin at $100. (New York’s bill would also develop a drug assistance pilot program to ensure access to insulin among uninsured populations.)

States are also exploring legislation that would allow pharmacists to prescribe and dispense emergency insulin to patients without a prescription. In May 2019, Oregon enacted SB 9 to allow pharmacists to prescribe and dispense emergency refills of insulin and insulin-related devices to individuals with evidence of a previous prescription. The pharmacist is also required to document the visit, provide patient education on diabetes management, and make a reasonable attempt to inform the individual’s primary care provider of the encounter. A New York bill, introduced in August 2019, would allow pharmacists to dispense emergency insulin and related supplies in a similar manner.

Expanding training on how to administer insulin has also been a focus of state legislative activity. Indiana enacted HB 1652 in May 2019, which requires that educational and training programs approved by the state health department for qualified medication aides include a module on administering insulin. At least one module must be approved by the end of the 2019 calendar year. The bill also allows qualified medication aides who are certified by the state to administer insulin in specific licensed health facilities. New Mexico enacted SB 48 in February 2019, which requires the public education department to ensure that annual diabetes training programs are provided for all school nurses and other personnel and include instruction on insulin administration.

Diabetes profoundly effects the American healthcare system and while actual new cases in the United States appear to be declining, many Americans continue to seek ways to control the disease. Achieving well managed diabetes is a top priority for state and territorial health officials and state legislatures are following suit as insulin prices grow. The current set of policy responses to this health crisis illustrate that affordability of insulin is a critical element of ensuring access to healthcare.