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Governor Northam Signs $50 Per Month Insulin Cap

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The passage of House Bill 66, sponsored by Delegate Lee Carter, gives Virginia the fourth-lowest insulin price cap in the country.

Gov. Ralph Northam recently signed a bill to cap the costs of prescription insulin copays at $50 per month, one of the lowest caps in the country.

House Bill 66, sponsored by Del. Lee Carter, D-Manassas, originally aimed to cap the costs of prescription insulin copays at $30 per month. By the time the bill passed the Senate, the cap was amended to $50 per month. 

Cheers and applause roared through the chamber when the bill seemed poised to unanimously pass the House, until a lone delegate changed their vote and groans replaced the cheers. But they still had something to celebrate –- Virginia will have the country’s fourth lowest insulin cap.

“For people that have diabetes, they tend to be on anywhere from five to eight medications. So even if they have good health insurance, paying copays anywhere from $5 or $10 per prescription adds up very quickly,” said Evan Sisson, professor at the VCU School of Pharmacy and vice-chairperson of the Virginia Diabetes Council. “So to be able to cap [insulin] is a huge benefit for patients.”

The Virginia Department of Health estimated in 2017 that 631,194, or 9 percent of Virginians, have Type 1 or Type 2 diabetes. 

Lee J. Carter on the campaign trail in 2017. Photo via CNS

The bill prohibits health insurance providers from charging a copay over $50 for a one-month supply, or from allowing or requiring a pharmacy to charge any more. The bill incorporates HB 1403, which was introduced by Del. James A. Leftwich, R-Chesapeake, and shares the same wording as Carter’s bill, but the copay amount was capped at $100.

“This bill is aimed at providing relief for those folks who have health insurance but can’t afford to use it; that is a vast swath of Virginia’s population,” Carter said during a Senate committee hearing. 

Insulin prices have risen so much in recent years that some diabetics have resorted to rationing their insulin, or traveling to Canada where the drug is much cheaper. According to Sisson, for someone with diabetes, especially Type 2, a lack of insulin can lead to major complications, and even be a matter of life or death.

“What the body does is it kicks into looking for other sources of energy other than glucose, and it starts to produce more fat,” Sisson said. “If you have more fat floating in the bloodstream, then you end up with more hardening of the arteries, of atherosclerosis. What that means is you have higher blood pressure, and higher risk of heart attack or stroke.” 

According to the U.S. House Committee on Energy and Commerce, approximately 30 million Americans suffer from diabetes, with that number increasing by about 1.5 million every year.

Prior to the advent of insulin in the 1920s, someone diagnosed with diabetes was expected to die in a matter of months, with restrictive dieting extending that to as long as a couple of years. When Canadian researchers completed the development of insulin in 1922, they sold the patent to the University of Toronto for $1, hoping that everyone who was affected by diabetes would be able to benefit from the life-saving drug. 

Since then, the price has constantly increased, dramatically so over the past few decades. In 2009, a 10 milliliter vial of insulin cost between $90 and $100. Today, that same vial will cost between $250 and $300, even though little about the drug has changed.

Virginia Capitol. Taken from the General Assembly website.

When HB 66 was sent to the governor, only two other states in the U.S. had hard caps for insulin copays. The first to introduce one was Colorado in May 2019, and the second was Illinois in January. Both states have their caps at $100 per month. 

In March, governors of six other states signed legislation capping the price of insulin. New Mexico, Utah and Maine set their caps lower than Virginia’s at $25, $30 and $35, respectively. West Virginia, Washington and New York will set caps at $100.

The new cost in Virginia will be reflected in insurance plans starting Jan. 1, 2021, coinciding with plans purchased during the next round of open enrollment, Carter wrote on Twitter. He added, “The fact that it had to be done this way is a reflection of how generally screwed up our healthcare system is.”

Written by Will Gonzalez, Capital News Service. Top Photo: A diabetic patient using an insulin pump. Courtesy of the Minnesota Department of Employment and Economic Development

Rx Partnership Fights To Make Medications Affordable For All Virginians

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Life uninhibited by the financial strain of healthcare: Rx Partnership works to provide Virginians with affordable medications across the state. 

Since 2003, Virginia nonprofit Rx Partnership and their associated clinics have helped provide access to free prescription medicine to over 68,000 uninsured Virginians, totalling over $150 million in retail value. 

Rx Partnership accomplished this feat by facilitating a relationship between pharmaceutical companies and 26 free clinics throughout Virginia, donating medicines in bulk to bring affordable care to folks throughout the Commonwealth. Through the process, the nonprofit has received donated prescription drugs from companies such as Merck, Novartis, GlaxoSmithKline, AbbVie, and Pfizer. 

“A lot of folks are being helped right now by Medicaid expansion, but at the same time, there are folks that make a little too much to qualify for that,” explained Amy Yarcich, Executive Director of Rx Partnership. “They’re not so well off that they can just open their wallet and afford an inhaler for their asthma for $125.”

Heads of households — who often work multiple jobs, providing for their families and putting food on the table — are the usual focus of these clinics. A recurring dilemma faced by these caregivers is the choice between medication for themselves and groceries for their family. 

“We look at it like [this]: the healthier the caregiver is, the better it is for the family,” said Yarcich.

Acting as a middle man, Rx Partnership cuts out expenses for clinics by buying prescription drugs. With the costs taken care of, individuals covered under PAP (Patient Assistance Programs for low-income people and those with no prescription insurance coverage) can receive treatment — and clinics are able to concentrate on serving more patients. 

“We keep a laser focus on medication access, and what we can do on a statewide scale,” said Yarcich. “That helps free up the clinics to really focus on patient care, and doing what they do best.” 

With 26 affiliated free clinics, Rx Partnership serves the whole Virginia community with licensed pharmacies. Each clinic is well-equipped with screening processes, which help them look at the income, household size, and access to insurance of their patients. This screening process is crucial to keeping the whole system running effectively, and to making sure those who need prescription medicine the most are able to get it at no cost. 

CrossOver Ministry receives support from Rx Partnership, and is the only free clinic in Richmond with a licensed on-site pharmacy. In order to qualify as a new non-Medicaid patient at CrossOver Ministries, patients must be at or below 200% of the federal poverty level and have no form of insurance. 

Their clinic serves a diverse part of the community, and saw over 6,000 patients in 2016, providing 49,000 prescriptions. Led by Leo Ross, a decade-long volunteer at the pharmacy, a staff of 24 pharmacists help in handing out more than $10 million in medications to the community. These medications provide uninsured individuals with the life-saving medications needed to function in their community, and to live life uninhibited by the financial strain of their health. 

In Richmond, CrossOver Ministry provides a variety of care for patients in one convenient location. All in one building, they provide services ranging from dental to vision health, HIV testing, and mental health services. By keeping all of their facilities under one roof, CrossOver Ministry is able to foster intimate relationships in a close knit community. 

“They know the names of the front desk staff, and there’s a relationship there,” said Yarcich. “That’s really important.” 

Thanks to the work of Rx Partnership, these clinics are able to help the vulnerable Americans who miss out on the benefits of health insurance. For the most part, patients are between the ages of 18 and 64. Those younger than 18 benefit from programs that help minors get insurance, and those older than 64 benefit from Medicare. It’s the patients stuck in the middle that Rx Partnership focuses on. 

Often times, individuals at the clinics are suffering from chronic conditions that make it impossible to operate at 100 percent — so even if they do go to work, both their families and their careers are damaged in the process. 

Yarich recalled several of their patients’ stories, in particular focusing on chronic illness that prevented them from going to work. An unemployed man, who suffered from several chronic conditions, was unable to afford his medication. Because of the assistance he received from the program, he was able to get back on his feet; he even started supporting his family and taking care of his kids again. She shared a similar tale of a woman in the same situation who was able to afford both her medication and her children’s Christmas presents thanks to the clinic. 

Along with their continuous fight to increase pharmaceutical company donations, Rx Partnership works to raise awareness of their organization’s services to patients across Virginia. At the moment, specific medications are donated through established programs and contracts between the nonprofit and medication companies — but there is still a swath of medications from generic manufacturers that would benefit the public just as much (if not more). 

In the future, Rx Partnership wants to start helping patients who are underinsured. These individuals might be able to afford insurance, but their coverage is such that they’re going to struggle to pay for medications and start skipping doses or splitting pills. 

As the debate on universal healthcare continues, the future is uncertain for Americans who rely on good health insurance to navigate their day-to-day life.  Despite this uncertainty, Virginian residents can trust in organizations such as Rx Partnership and its clinics to act as a safety net for themselves and their families. 

Virginia Takes Steps to Keep Prescription Prices Down

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Virginia has become the first state to ensure that patients will be the ones to see benefit from prescription drug coupons — not their insurance companies.

Last month, Virginia Governor Ralph Northam signed two bills that will require health insurers to count drug and medicine coupons toward a patient’s deductible.

This bill, which will take effect July 1, was introduced to help protect patients from the rising costs of prescriptions. It was introduced to prevent insurance companies from profiting from drug coupons and copay assistance, while the patients using the coupons get nothing.

The legislation was carried by Republicans Sen. Siobhan Dunnavant of Henrico, and Del. Timothy Hugo of Fairfax.

“I introduced SB 1596 [HB 2515] because I had so many patients that came to me and complained,” stated Dunnavant. “When they went to to the pharmacy to fill a prescription, they either had to pay a really high copayment that applied to their deductible or, if they used a coupon and got it for a less expensive price, they could not apply that [coupon] to their deductible. That just didn’t seem fair to me.”

This frustrating situation was coming to pass because of choices employers and health insurers had made in order to maximize their profits, and pass rising drug costs on to patients, rather than bearing it themselves.

“[Patients] were paying the cost of their prescription,” stated Dunnavant. “They had the opportunity to get a lower-cost alternative, and they were disincentivized by their insurance plan to go with the lower-cost alternative.”

Drug manufacturers often provide copay assistance — coupons or discounts — directly to patients who’ve been prescribed the drug, in order to help save patients money. In this way, manufacturers help cover the patient’s out-of-pocket costs for a specialty or brand-name medicine and, by doing so, continue to get the patient’s business. Patients often use copay assistance to help cover the cost of drugs for a variety of illnesses and conditions. This includes conditions that are incurable, or take years to treat.

Typically, insurance companies will apply the manufacturer’s coupon towards the patient’s annual deductible. While this action does not reduce the patient’s cost for that prescription, it does allow patients to reach their deductible faster and at a cheaper cost than if they paid directly out-of-pocket. Once their deductible or yearly maximum is reached, the patient’s insurance then pays for the additional prescriptions.

However, 2018 saw the introduction of a new program, first introduced by UnitedHealthcare. In this new program, employers, plan sponsors, or patients can purchase an insurance policy that utilizes what are called “copay accumulators.” These programs prevent coupons or copay assistance from counting towards a patient’s deductible or out-of-pocket maximum, allowing insurance companies to avoid the full cost of the drug, passing as much of it as possible along to the patient.

Critics argue that this new program may cost patients thousands of dollars a year. However, insurers claim that the new program is necessary to keeping drug manufacturers from jacking up their prices.

The problem is that, since drug manufacturers are raising the prices on specialty drugs, patients are increasingly relying on coupons and copay assistance to afford their medication. Regardless of the intention, the reality is that copay accumulators are reducing the affordability of essential medicines. While out-of-pocket costs are rising for patients, both manufacturers and insurers are profiting.

Not only can higher prescription costs can be financially damaging, some medications do not have a generic equivalent. Therefore, thanks to the increasing costs of medicines coupled with the decreased affordability that comes with copay accumulators, patients who require specialty drugs may be forced to stop filling their prescriptions.

Virginia legislators have now taken steps to protect patients from copay accumulators. Governor Northam signing this bill into law makes Virginia the first state to do so, although West Virginia passed a similar bill around the same time, and eight other states are reportedly considering similar legislation.

“Healthcare costs are already exorbitant for almost every Virginian,” stated Del. Hugo in a press release. “This is a meaningful step to lower out-of-pocket costs for hardworking Virginians.”

Additional reporting by Marilyn Drew Necci. Photo by Joshua Coleman on Unsplash