Colorado insulin reform offers additional option for affordability

Colorado just took a big step forward to help make insulin affordable for diabetics. After Minnesota lawmakers' disgraceful failure to enact the Alec Smith emergency insulin bill, policymakers should look to this Rocky Mountain state for inspiration as they tee up solutions now, not later, for the 2020 session.

On May 22, Colorado Gov. Jared Polis, a Democrat, signed what is believed to be the nation's first state law capping insulin "co-payments" — the out-of-pocket contribution that insurers often require of consumers when prescriptions are filled. The measure will prevent many, but not all, privately insured consumers from paying more than $100 a month for insulin.

Polis heralded the law's passage as an end to the "days of insulin price-gouging." That's a stretch given states' limited regulatory authority, but the measure is progress nonetheless. The price of insulin per prescription increased "from $344 in 2012 to $666 in 2016," according to the Health Care Cost Institute. The price hikes understandably have made it difficult for those with diabetes to afford this vital medication, especially because multiple injections may be needed daily to control blood-sugar levels. An estimated 30.3 million Americans, or 9.4% of the population, have diabetes.

Rationing insulin or going without may have deadly consequences. Alec Smith, the young man who inspired the Minnesota bill, died in 2017 after he aged off his mom's insurance and struggled to afford the medication. Tragically, others have suffered a similar fate. In January, Antroinette Worsham testified before a U.S. House hearing that her 22-year-old daughter died after rationing insulin.

The pharmaceutical lobby's might makes cost control a monumental challenge at the state and federal levels, which is why it's sadly not a surprise that the Minnesota emergency bill didn't get across the finish line. The measure, championed by DFL Reps. Mike Howard and Laurie Halverson, sought funding from insulin manufacturers to make a limited supply of medication available to those who couldn't afford it.

This was a reasonable ask given that another bill, one that did pass this year, successfully tapped opioid drugmakers and distributors to help pay for opioid addiction treatment and prevention. But it took three years for that bill to pass, even in the midst of a national painkiller addiction epidemic.

Given the drug industry's clout, the passage of the Colorado bill is a remarkable feat. It was also a labor of love. Rep. Dylan Roberts, the Democratic legislator who introduced the bill, had a younger brother who died of diabetes.

A similar measure in Minnesota would work well in concert with the Alec Smith bill to fill insulin affordability gaps. The Smith measure is aimed at emergency access, while the Colorado reform would bring broader, ongoing cost relief. Still, as Roberts acknowledged in an interview, it won't help everyone. Many employer-sponsored health insurance plans are regulated by federal authorities instead of states, so the cap wouldn't apply to this coverage. The cap also only benefits those who do have insurance.

Another drawback: There's a cost shift. Insurers will still pay full price to insulin suppliers, and then pass along unreimbursed costs due to the cap to policyholders. But Roberts said that is likely to amount to pennies per month per premium.

The limits on states' resources and authority requires long-term drug price solutions to come from Congress, but states need to do what they can until then. The Alec Smith emergency insulin bill and the Colorado cap are smart examples of pragmatic fixes. The work to identify reforms and forge the bipartisan support necessary to make them a reality in Minnesota's divided government should start now.