New State Law Keeps Insulin Affordable, But Only For 16% Of Texans
Senate Bill 827 set $25 caps on copays for the life-saving drug for those in state-regulated health insurance programs. Texas is the 19th state to enact such a law.
KERA’s Sam Baker asked Betsy Richter-Gifford, an Inpatient Diabetes Care & Education Specialist with Texas Health Resources, if the new law is a game-changer.
About The Bill:
This bill limits the copays to $25 for each insulin prescription per month for insured Texans that are on state-regulated health plans, like state employees, those on Affordable Care Act plans within the state. Obviously, your state-managed Medicaid. About 16% of Texans have state-regulated health plans. So I would say this bill is a step in the right direction.
Other states have passed bills like this, California, for example, found insulin copay caps reduced emergency room visits, resulting in lower healthcare system costs. This was of course, due to the increased insulin utilization by people with diabetes, because they can take their insulin as prescribed.
There are still many Texans that were not included with this bill. Even with insurance, insulin can cost between 300 to a thousand dollars a month.
What Others Pay
Every plan is different, every pharmacy benefit is different, but many people with commercial insurance still pay hundreds, if not thousands, of dollars, depending on what kind of plan they have to get their insulin prescriptions.
Some of the literature from the ADA is very staggering:
- One in four insulin users said that cost impacted their insulin use.
- 30% choose between insulin and utilities.
- 27% choose between insulin and housing.
- 26% take less than prescribed.
- 23% missed doses, weekly.
- 23% change to less expensive brands.
- 36% choose between insulin and other medications.
So I mean, people are having to make difficult decisions for a medicine that they need to survive.
The Good News
There are many national efforts underway to improve insulin costs for those living with diabetes. I chair the Texas coordinating body for the Association of Diabetes Care and Education Specialists. And my colleague, Carol Howe, has been very active in the advocacy efforts, along with others at the state level. And legislators recognize this issue and we're willing to move on a bill to improve insulin affordability.
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