Illinois lawmakers gave a proposal to cap the payer cost of insulin its first endorsement, but questions remain about the consequences of the cap and what the market already offers.
The Senate gave an amended Senate Bill 667 mixed reviews, but it got enough support Tuesday to pass. It now heads to the House for a vote.
If enacted, the measure would cap the cost of insulin at $100 for a 30-day supply.
“I think we all have stories from constituents in the districts we represent [about] out of pocket costs for insulin which is a necessary drug for those that are diabetic to stay alive,” state Sen. Andy Manar, D-Bunker Hill, said. “We are an outlier be every single metric that anyone has ever shown me and that has to be addressed.”
Manar’s legislation mirrors a law enacted in Colorado in May. The Illinois measure specifically caps a consumer’s out-of-pocket costs, leaving the additional cost to be sorted out by the manufacturers and insurance companies, many of which oppose the measure.
“Any time we adjust some area, we cap something, we’re gonna have to adjust it in our actuarial values elsewhere,” said Laura Minzer, who represented the Illinois Life Insurance Council at a hearing on Monday.
The legislation would only apply to fully-insured plans, not entities that are self-insured. Minzer said that equals “about 20 percent of the market.” The Illinois Attorney General’s office would also be instructed to conduct study the costs of insulin in an effort to protect consumers.
The average cost of insulin for the average-sized person with Type 1 diabetes is hundreds of dollars per month, according to estimates from GoodRx.com, although it offers a number of ways to reduce that cost.
“It’s important to note that resources currently are and have been available to diabetes patients in the form of assistance programs,” said Peter Fotos, senior pharmaceutical director for the Pharmaceutical Research and Manufacturers of America.
Manar said that assistance wasn’t enough for those who depend on insulin to live.
The amended version would take effect in 2021.