Montana takes another shot at passing an insulin co-pay cap bill

Alison Sharkey-Hines said her son, who was born premature and died at two weeks old, might still be here if she had access to affordable insulin.

After rationing her insulin, she said her son Kilian Riley Hines was born with underdeveloped lungs, and due to a rare disease, he did not have a gallbladder or a spleen. He also had a birth defect that impacts blood flow to the heart.

“It was all caused because I could not control my diabetes, because I could not afford my insulin,” she said.

Sharkey-Hines testified as a proponent on Senate Bill 340, which would cap the insurance copay on a 30-day supply of insulin at $35. According to a 2015 Johns Hopkins study, insulin can often cost anywhere from $120 to $400 per month without prescription drug insurance.

Bill sponsor Sen. Jason Small, R-Busby, said 20 other states have enacted similar legislation. At the federal level, Medicare patients will already see a $35 cap on insulin co-pays under the Inflation Reduction Act.

The Senate Business, Labor and Economic Affairs Committee heard from 17 proponents on Tuesday, including organizations like the Montana Pharmacy Association, the American Diabetes Association and AARP Montana. No opponents testified.

Proponents spoke to the complications that can come with rationing insulin, which range from harmful to fatal, including blindness, amputations, heart attacks, strokes and kidney failure.

“At any given time, we have somebody admitted because of this, because they could not afford their insulin, ration their insulin and became very sick,” said a diabetes nurse out of Butte, Ida Reighard.

Reighard said she spends her time trying to find coupons for patients who can’t afford the treatment. She said it’s also not uncommon for patients to charge insulin to credit cards until they hit their deductible and then try to pay down credit card debt.

Adrian Cotton, with the Montana AARP, said SB 340 mitigates the impact of pharmaceutical price-gouging on Montana’s older population.

Cotton attributed the high cost of insulin to three companies controlling 90% of the global market, “allowing for cost setting without meaningful competition.”

“Marketing, lobbying, price-fixing and the pressure on the U.S. market to support worldwide pharmaceuticals contribute to our high cost of insulin,” she said.

When insulin was discovered, the patent was sold for one dollar, according to Marci Butcher, with the Montana Association of Diabetes Care and Education Specialists.

“Meaning they wanted everyone who needed to have access to it,” she said.

The estimated cost of producing a vial of analog insulin is between $3.69 and $6.16, said Carissa Kemp with the American Diabetes Association.

“This low cost of manufacturing this insulin is clearly not translating through to how much the patient pays,” she said.

Kemp said people diagnosed with diabetes spend an average of $16,752 per year on medical expenses and overall pay over twice as much as someone without diabetes.

“Lowering the cost of insulin for people with diabetes can ease this unsustainable financial burden they must bear,” she said.

Stacey Anderson of the Montana Primary Care Association highlighted language in the bill that protects patients who otherwise would have to pay high deductibles before insurance would start covering their medication.

“The first time you go to fill your insulin in January of the new year, your copay is $35,” she said.

A similar bill to reduce the price of insulin was introduced during the 2021 session, where Sharkey-Hines also testified in support. That bill, sponsored by then-Rep. Willis Curdy, D-Missoula, would have capped insulin at $100 a month, but was tabled in committee.

Health insurance companies spoke in opposition to the bill during the last session.

Now-Sen. Curdy sits on the committee that heard the bill Tuesday.

Small said in closing that the effective date was set for January to give insurance companies time to set their policies. He said Blue Cross Blue Shield, an insurer in the state, covers more than 50 types of insulin, and an appeals process is in place for insulin types it does not cover.

“This bill is beneficial to nearly one-tenth of this state, helps regulate expense for those in need, and it’s going to keep a lot of people alive,” Small said.

The committee did not immediately take action on the bill Tuesday.

Nicole Girten is a reporter for the Daily Montanan, a nonprofit newsroom. To read the article as originally published, click here.