Lawmakers moving toward payment caps for insulin and other drugs
Joining a handful of other states, the Connecticut legislature appears likely to make capping or controlling prescription drug prices a top target in the 2020 legislative session slated to begin next month.
Sen. Matt Lesser, D-Middletown, co-chairman of the legislature’s insurance committee, said the cost of and access to insulin, the main drug used to treat diabetes, will be of particular concern.
“We’re hoping that we’re going to make this a real big issue that the legislature can come together to bring pocketbook relief to families,” Lesser said.
Insulin, which diabetics need because their bodies don’t make it adequately, can cost upwards of $1,000 per month. Last March, one of the companies that dominates the insulin market, Eli Lilly, pledged to distribute a generic form of Humalog, its brand name, $300-per-vial insulin, at half the price.
A broad health cost reform package failed last year in the General Assembly, without coming to a vote, in part because of opposition from health insurers in Connecticut, chiefly Cigna. Details or proposals for 2020 are still coming together.
But a survey conducted by the offices of U.S. Sens. Richard Blumenthal, D-Conn., and Elizabeth Warren, D-Mass., found the generic was not available in 83 percent of pharmacies. Many pharmacists were unaware of, or not adequately informing their customers, about the availability of the lower-cost alternative.
The high cost of the life-saving drug has made headlines for years as some diabetics attempt to ration their costly prescription only to succumb to the disease.
“Obviously I think the federal government needs to act, but in the interim, putting some big ticket health reforms at the state level will set the ground for federal reform,” Lesser said. “It’s something that both red states and blue states are dealing with, and our big models are actions by Republican governors in Florida and Massachusetts.”
In October, Massachusetts Gov. Charlie Baker put forward a bill that would require all providers and insurers to boost spending in primary care and behavioral health, penalize excessive drug price increases and limit surprise emergency billing.
In June, Florida Gov. Ron DeSantis signed legislation authorizing the state to import prescription drugs from Canada and other countries, potentially lowering the cost. Vermont was the first state in the country to enact a drug importation law.
Colorado Gov. Jared Polis signed a similar bill in May and that state also became the first to cap insulin co-pays, regardless of how much insulin a patient uses, at $100 per month. The law, signed by Polis in May, also enlists the Colorado attorney general to investigate the rising prices of insulin in the state and to make recommendations back to the legislature.
Though such an importation law would require federal approval, the Trump Administration, along with the U.S. Department of Health and Human Services and the U.S. Food and Drug Administration, issued a notice of proposed rulemaking in December that, if finalized, would allow for the importation of certain prescription drugs from Canada.
“We are looking to work with the Administration and looking at what other states are doing to address this,” Lesser said. “Not only are prescription drug prices increasingly unaffordable for families. But they’re also a big budget buster for the state as well.”
Drug cost reform is not just a priority for Lesser, for whom the issue is personal — he has severe food allergies and carries an EpiPen — but for the entire Senate Democratic caucus, which will finalize its list of priorities in the coming days. Lesser also said he and his insurance committee co-chairman, Rep. Sean Scanlon, D-Guilford, are working with advocacy groups such as AARP and JDRF, the largest nonprofit funder of type 1 diabetes research, as well as Republican legislators to address the issue this year.
“We do intend a number of public health and health insurance reforms,” said Senate President Martin Looney, D-New Haven. “Dealing with tackling the cost of prescription drug prices in Connecticut, and closely related to that, looking at what two other states have done ... to cap the price of insulin and made it so people can get insulin in an emergency. It’s a priority because it’s something that we hear about from our constituents.”
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