Insulin reform: ‘Your money or your life’

Bill Knight column for 10-31, 11-1 or 2, 2019

Diabetes is the nation’s seventh leading cause of death, according to the Centers for Disease Control, more than the flu and pneumonia, kidney disease and suicide. And in Illinois, about 12.5 percent of the state’s population – some 1.3 million people – have diabetes, according to the Illinois Department of Public Health.

“Diabetes affects people from all walks of life,” said Gov. JB Prizker,, “but as prices have skyrocketed, more and more insulin users have been forced to find their medication by substituting lower quality products, or seek options out of the country, or even ration their supply. Some have died doing so.”

This month, state officials said that in the last 30 years, the price for insulin has increased more than 1,200 percent – 12 times its price in the 1990s. And without intervention, drug makers’ pricing/profiteering crisis has no end in sight.

So state Sen. Andy Manar (D-Bunker Hill) proposed the Comprehensive Health Insurance Plan Act (originally Senate Bill 667). If passed, the legislation – similar to a law that Colorado lawmakers approved in May – would limit the amount paid for insulin to $100 for a 30-day supply.

First filed in May, the measure is expected to be re-introduced in the General Assembly’s veto session, which started this week and resumes Nov. 12-14.

This is far from abstract to many Americans. A buddy’s California granddaughters need insulin to stay alive, and their mother said the $971 bottles of insulin their family spends monthly for them to live is an obvious burden.

“I lost sleep while big medical CEOs slept fine in their mansions with silk sheets and 20 bathrooms, with their multiple cars and private jets,” the girls’ mom said. “I lost sleep wondering what we would do.”

Opponents say such cost controls could stifle innovation and force insurers to pass on the higher costs to other policyholders. However, in Colorado, the difference will be negligible, according to more than 20 health plans’ proposals for 2020 rates submitted to Colorado’s Division of Insurance, as reported in the Colorado Sun newspaper.

After all, the price tags aren’t from insurance companies, but Big Pharma, an industry that’s inflated prices beyond reason.  A recent BMJ Global Health study shows that the actual costs of manufacturing insulin – including ingredients, production and delivery – are between $2.28 and $3.42 for a 10-milliliter vial of insulin (about one-third of an ounce), meaning that the cost of a YEAR’S supply is between $48 and $71.

So pharmaceutical companies such as Eli Lilly, Novo Nordisk and Sanofi – the corporations that manufacture 96 percent of the country’s insulin – will still make a profit from $100 a MONTH.

“Big Pharma, whose ultimate aim is not to cure diseases, but to bloat their stock prices, enrich their investors and reward their CEOs with outrageous salaries and golden parachutes when they retire,” said New York journalist Karen M. Garcia.

Not incidentally, taxpayers won’t be on the hook for the difference between $100 and Novo Nordisk’s Novolog brand’s $351 price.

“The cap requires insurers, PBMs [pharmacy benefit managers], and manufacturers to take this state law into account when they are negotiating formularies and designing insurance plans,” said Jennifer Allison, District Director for state Sen. Dave Koehler (D-Peoria). “It guarantees that a patient with a plan impacted by this law would only spend $100 total per month on insulin.”

Differences between manufacturers’ prices and the $100 “definitely would not be borne by the state,” she added.

If the proposal has a weakness, it’s that it doesn’t go far enough.

Like Colorado’s law, which goes into effect in January, Manar’s bill would cover people who are insured, so Medicare and those in some employer “self-funded” plans apparently wouldn’t be protected. The bill says, “An insurer that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the insurer offers shall limit the total amount that an insured is required to pay for a covered prescription insulin drug at an amount not to exceed $100 per 30-day supply of insulin, regardless of the amount or type of insulin needed to fill the insured's prescription.”

About 850,000 Illinoisans were uninsured last year, according to the United Health Foundation.

If approved, Illinois’ insulin cap would be enacted next June.