The Fight to Cap Rising Insulin Prices for Diabetic Patients

On May 22, Colorado governor Jared Polis signed a bill into law capping the price of insulin at $100 per month for patients with insurance.

Colorado is the first state to create a law designed to battle what is seen by many as price gouging by pharmaceutical companies. Research published in the Journal of the American Medical Association shows that  the average cost of insulin rose by almost 200% from 2002-2013, making it the latest in a growing trend of exorbitant healthcare costs for Americans.

The rising cost of medication means diabetic patients sometimes forego their medication, or take altered doses, in order to make supplies last longer. This technique is often called rationing and can have many consequences.

“Even if you get some of your medication and not all of it, your diabetes eventually gets out of control,” Dr. James T. Cail III, a physician with Primary Care Partners in Edmond, said. “And we’re talking about increased visits to the emergency room, increased costs of people that are paying for that – the cost is typically spread out through other means such as taxpayer money and things like that.”

Diagnosed diabetes cost the United States over $300 billion in the year 2017, according to the American Diabetes Association. Access to many medications, including insulin, is a matter of life and death for patients.

“We have a healthcare crisis in our nation,” Cail said. “We have hardworking people, that are good people, that are unable to get basic healthcare because it’s simply unaffordable to them.”

Cail chooses not to work with insurance companies because of problems with the private insurance model. Instead, his office operates under a healthcare model called direct primary care. His office has an on-site pharmacy that can prescribe many generic medications for less than the copays most insured patients pay.  

Additionally, there have been numerous congressional hearings in Washington, D.C. to discuss the problems with insulin pricing for the insured and uninsured. While the new Colorado legislation means the cost of insulin will have a cap for patients with insurance, advocates see the limitations this version of the bill might have in a state like Oklahoma and say more can still be done to increase affordability and access for everyone. 

“Colorado has a very low uninsured rate, whereas here in Oklahoma we have the second highest uninsured rate in the country. While this law is potentially very beneficial to those with insurance, it does nothing to help those without insurance who bear the brunt of our broken system,” Dr. Clayton McCook, leader of Oklahoma’s chapter of T1International’s #insulin4all movement said.

McCook is an Edmond resident and veterinarian, whose almost 11-year-old daughter Lily was diagnosed with Type 1 Diabetes when she was three. In his advocacy work, he has seen that going toe-to-toe with the pharmaceutical companies is no easy task.

“The biggest struggle is access. I’m not a lobbyist or a donor or a major player in the political world,” McCook said. “I’m just a dad who is trying to fight for his daughter’s future and that of other people who literally need insulin to live.”

Pharmaceutical companies are regulated in many countries around the world, placing limits on the amount patients can be charged for medications. However, the U.S. does not currently have any federal restrictions on the pricing of prescription drugs, causing Americans to foot a much higher bill.. 

“I’d like to see the United States join the rest of the world and stop allowing the pharmaceutical industry to dictate what people with diabetes have to pay for their insulin and other drugs. It is inexcusable that I can fly to Canada or drive to Mexico and purchase the same exact insulin that costs over $300 a vial here for less than $50,” McCook said. “It is long past time that we negotiate prescription drug prices like they do in other countries, and I believe it is imperative that we set price caps on drugs like insulin that are literally required for survival.”

McCook isn’t alone in his feelings. Nationally, advocates have been outspoken about the high cost of the drug and the limited response from those in charge.

I’m not going to be sending any thank-you flowers to Eli Lilly for this new “bargain” pricing scheme, after hiking the price of Humalog more than 35 times – from $21 to $329. Big Pharma has to stop its price gouging of insulin patients: https://t.co/ZdfgIokZe5

— Senator Dick Durbin (@SenatorDurbin) March 6, 2019

Rep. Forrest Bennett from Oklahoma City introduced a bill similar to Colorado’s in Oklahoma’s last legislative session. However, Rep. Lewis Moore from Edmond, chairman of the Insurance Committee, refused to allow that bill to be heard and it died in committee, according to McCook. A national bill, H.R. 1478, the Affordable Insulin Act of 2019 was also introduced in Washington in February and Congressional committees continue to hold hearings on the matter.

Advocates for changes to the system like Cail and McCook applaud those who are working to make changes, but say there is still more to be done by all, both locally and nationally. For now, diabetic patients and their families, hoping for a solution to high healthcare costs, continue to wait.

UCO students with health concerns can visit the Center for Counseling and Well-Being or make an appointment with the OU Physicians Health Clinic on Campus.