May 23, 2019 at 10:11am
-Craig Idlebrook
Yesterday, Colorado governor Jared Polis signed into law a measure that will cap total monthly insurance co-pays for insulin at $100. All insurers in the state will have to comply with the new regulation by January 1st, 2020.
The measure caps out-of-pocket costs for a 30-day supply of insulin at $100 for Coloradans with insurance. However, it does not provide a similar cap for out-of-pocket insulin costs for those in the state who lack insurance, nor does it cap out-of-pocket costs for other diabetes supplies.
The legislation also requires the Colorado Department of Law to investigate insulin pricing practices by pharmaceutical companies, pharmacy-benefit managers (PBMs), and insurers, and generate a report that will be made available to the public by November 1st, 2020.
The legislation does not block insurers or PBMs from offering monthly insulin copay caps lower than $100. Such a carve-out may prove important in the future, as insurers and PBMs have been under intense political pressure to cap out-of-pocket insulin costs. Recently, Cigna and Express Scripts rolled out a program in which participating customers will pay no more than $25 for a 30-day insulin supply.
The legislation’s passage was cheered by diabetes and disability advocates, including the American Diabetes Association.
The Colorado BioScience Association, CVS Health, United HealthCare, and Pharmaceutical Research and Manufacturers of America (PhRMA) all opposed the legislation, according to a regional policy report. Reasons to impose the measure included that it has the potential to drive up insurance plan costs and that it is being administered by the Colorado Department of Law, rather than state insurance or health care policy regulators.
This appears to be the first state law aimed specifically at capping insulin out-of-pocket costs. Many other states are considering bills aimed at reducing the economic burden of the insulin pricing crisis, according to a Healthline report.
You can read the final text of the new law here.