Insulin is a hormone produced by the pancreas that regulates blood sugar levels. Many individuals with diabetes require insulin injections to regulate blood sugar. Health plans, including health plans offered to public employees and covered dependents, must cap the total amount that an enrollee is required to pay for a 30-day supply of insulin at $100. Prescription insulin drugs must be covered without being subject to a deductible, and any cost-sharing paid by an enrollee must be applied toward the enrollee's deductible obligation. The cap expires on January 1, 2023.
Health plans issued or renewed on or after January 1, 2023, must cap the total amount that an enrollee is required to pay for a 30-day supply of a covered insulin drug at $35. This cap expires January 1, 2024. The cap applies to health plans offered to state employees and covered dependents.
(In support) Reducing the cap for insulin cost-sharing from $100 to $35 improves the quality of life for individuals with diabetes. It is difficult to live in fear of not being able to afford medication, and patients with diabetes also need to purchase other treatment components in addition to insulin. Individuals with diabetes are making decisions like going to college or getting married based on the cost of insulin. Some individuals with diabetes ration insulin which jeopardizes their lives. If this bill does not pass, the $100 cap will end, and patients will go back to paying what was being charged. Health insurers purchase insulin in bulk, so they have the ability to price insulin at an affordable level. The cost of insulin has increased beyond the cost to produce it. Reducing the cap will not cause health insurers to raise premiums because premiums did not rise after the $100 cap was passed. This cap aligns with a national effort to cap insulin cost-sharing at $35. The bill should also address emergency access to insulin, so that individuals with diabetes can refill their insulin supply once per year regardless of insurance status.
(Other) The Total Cost of Insulin Work Group (Work Group) was not able to do its work, so the $100 cap should remain moving forward while the Work Group convenes. A $35 cap is beneficial for consumers, but it will drive the cost of insulin into health insurance premiums.