Diabetes medicine costs could be capped via HB 263

Eric Mabus, owner of Bayard Pharmacy in downtown Dover
Eric Mabus, owner of Bayard Pharmacy in downtown Dover, shows a pack of the insulin pens that many diabetics use in order to control their disease. (Delaware State News/Mike Finney)

DOVER — For those people coping with diabetes, the cost of insulin to treat the disease can easily be more than $6,000 per year. That’s a high price to pay, but an added expense that is necessary if diabetics want to stay alive.

That’s why Rep. David Bentz, D-Bear, Newark, New Castle, along with other House Democrats, formally introduced House Bill 263 Thursday in an effort to cap the cost of insulin, making the vital diabetes medication more affordable.

“There’s no easy way to say this: There is no cure for diabetes. Patients can manage the disease for a better quality of life, but how can they do that if insulin prices continue to soar through the roof?” said Rep. Bentz, the House Health and Human Development Committee chairman and lead sponsor of HB 263.

“Insulin is a vital medication, but its high cost often forces people to make risky choices, like skipping doses and rationing vials just to get by each day. These costs, which disproportionately impact those with less means, can be literally life-threatening. I’m proud that Delaware is taking a stand to limit the cost of insulin and make it more affordable to those that need the care.”

Under the proposed HB 263, “people with individual, group or state employee insurance plans will pay no more than $100 per month for prescription insulin, regardless of the amount or types of insulin they need to fill. The bill also addresses affordability by requiring insurance plans to include at least one insulin medication on the lowest tier of the drug formulary developed and maintained by the insurance carrier. Drugs cataloged at this tier will typically cost less.”

Diabetes is a disease that affects nearly one in four adult Delawareans.

In Delaware, the prevalence of diabetes has almost doubled, from 4.9 percent in 1991 to 11.5 percent in 2015. More than 85,000 adults in the state have diabetes, affecting 15.1 percent of African Americans and 11 percent of Non-Hispanic Caucasian adults, according to HealthyDelaware.org

In 2012, the American Diabetes Association estimated the total cost burden of diabetes for Delaware was $860 million.

One study from the Health Care Cost Institute, which dissected insulin costs for Type 1 diabetes patients, found that the cost of insulin nearly doubled from 2012 to 2016. Going further, those patients spent $5,705 per person on insulin in just 2016.

If passed, HB 263 would impact insurance plans beginning in 2021. Illinois and Colorado also have passed similar legislation to address insulin costs.

“So many of our neighbors are facing impossible decisions about health care costs. People with diabetes are among those losing out most,” said Sen. Bryan Townsend, D-Newark, Bear, Senate prime sponsor of the bill prefiled Thursday. “The cost of the insulin they need every day just to stay alive keeps rising, and there is no signal that the private sector is addressing this crisis.

“People’s dire need for a basic substance should not justify sky-high prices. “

High costs impact diabetic’s life choices

Diabetes impacts the way the body processes dietary glucose, causing changes to blood glucose levels within the bloodstream. Untreated, the disease can cause significant health complications from nerve and kidney damage to heart issues. Prescription insulin helps to treat the disease.

According to HealthyDelaware.org, the diabetes mortality rate has declined over the past two decades. However, the diabetes mortality rate for African-Americans in Delaware is more than twice the diabetes mortality rate for Caucasians in the state.

Allan Scrutchfield of Hartly has been living with diabetes for the past 14 years and he often has questions about why the price of his medication is so high. He estimated that he pays around a $300 co-pay every three months for his prescriptions.

He also said that without insurance, his diabetes medication would cost more than $3,000 each time he refills it.

“What really gets me is when people complain that people who overdose on drugs can get Narcan for free when diabetics have to pay so much for their medicine,” Mr. Scrutchfield said. “That’s not really the question.

“The question to me is why is the cost of insulin so high when a couple of people from Canada who developed the medicine never put a trademark on it so that it would be affordable to people who needed it? That is what doesn’t make any sense to me. I can see why some people just say, ‘Forget it, I’m going to eat what I want to eat and then suffer the consequences.’”

Rep. Andria Bennett, D-Dover, agreed with Mr. Scrutchfield and said it does not make sense the choices that diabetics are forced to make just to be able to afford insulin.

“We should be ashamed that Delawareans — our neighbors and constituents — are having to decide whether to take their medication daily or pay for the clothes on their backs,” said Rep. Bennett, co-prime sponsor of the bill. “We have to act to lower the cost of this critical, lifesaving medication.

“The fact that insulin costs a person thousands of dollars of a year shows us that we’ve lost sight of the true meaning of health care. Limiting the amount of money a person has to pay out of pocket for their medication substantially impacts their quality of life. This legislation builds upon our efforts to make medication more affordable and accessible, so that trips to the pharmacy are not rife with anxiety and worry.”

Legislation a light of hope?

Eric Mabus, owner of Bayard Pharmacy in downtown Dover, said he believes the legislation could help many of the customers he sees on a regular basis.

“This is something that is really needed,” Mr. Mabus said. “We deal with diabetics regularly and work with people who can’t afford their insulin. We often see customers whose co-pays are $400 to $500 a month for a two-month supply of insulin. This legislation will make a huge difference for them.”

Mr. Mabus said there are other ways to save on insulin and other prescriptions, such as printing out coupons online, but he wondered why those affected need to take that route.

“It is an interesting topic,” he said. “A lot of medications, the co-pay might be extremely high, but they offer online coupons. I often wonder that if (the drug companies) can afford that price with the coupon, then why not just make that the price? Sometimes, it doesn’t make sense.”

When it comes to measuring the impact the disease of diabetes has in Delaware, the numbers are staggering.

Nearly 24 percent of the state’s adults — nearly one-quarter — battle diabetes or are at risk of developing the disease, according to a recent state health report from the Delaware Department of Health and Social Services.

According to the Centers for Disease Control and Prevention, more than 30 million adults in the United States have diabetes, while one in four of them don’t even know they have it.

“Insurance companies are not doctors, and patients should not be forced to play Russian roulette with their health care just because an insurance company does not offer a lower cost medication. Delawareans deserve better access and pricing for their needed treatments,” said Rep. Melissa Minor-Brown (D-New Castle), co-prime sponsor of HB 263.

“Managing diabetes takes an all-hands-on-deck approach, from preventive programming to access and affordability. We are taking aim at a major piece of this epidemic with this legislation, and hopefully lessening the burden that Delawareans will feel in their daily lives.”