EVANSVILLE, In. (WEHT) — Two bills in two states: both tackling life or death decisions diabetics are often forced to make to afford insulin.
One proposed bill seeks to make insulin more available.
The other attempts to cap co-pays after the price of insulin skyrocketed in recent years.
On Wednesday, the Kentucky House voted to pass House Bill 12, which would cap out-of-pocket co-pays at $100 per 30 days.
That now moves to the Senate.
That same day in Indiana, Senate Bill 255 passed committee and will go to a full vote on Monday.
That bill eliminates the need for a prescription from a doctor to get insulin, which may make it easier for people to get medication if they can’t access a doctor.
An amendment to add a $100 co-pay cap to that bill did not pass.
For many patients like Russell King, the need for help is very real.
“Getting access of insulin for our patients is not necessary a problem from a physician’s standpoint or a nurse practitioners standpoint,” says Dr. David Schultz at Evansville Primary Care. “The greater problem is affordability to the patient. Our patients are not able to afford these high prices of insulin, which often run $400 to $600 dollars per month.”
He says for some patients, that means having to choose.
“The price is often way out of their price range to be able to afford. As a result of this, several patients will likely not take enough of the insulin prescribed, or not take it at all.”
“It’s either food on your table, or your medicine,” says King. He says he’s been faced with that situation before. “So you let go of the medicine for a little while, and you do it sparingly. Miss a dose, take a dose.”
King lives in Indiana, but even if he lived across the river, the Kentucky co-pay cap bill wouldn’t help him, because he is on disability.
“It’s impossible to buy your insulin if you don’t have regular coverage.”
The bill only covers those with state-regulated insurance. That would still leave others like him with a hard pill to swallow, and a tough decision to make.
“My insulin costs me almost $900 dollars a month.” […] “I have missed quite a few times. Especially after I’ve reach the doughnut hole.”
That “doughnut hole” or Medicare prescription coverage gap, means drug coverage costs come out of pocket up to a yearly limit.
But insurance and manufacturers pricing are the only things piling on.
Costs can differ between pharmacies.
A simple search on apps like GoodRX show the same insulin type priced over 40 dollars higher at pharmacies within miles of one another.
“Many insurance plans do not simply cover it, or do not adequately cover that.”
Right now, for many diabetics forced to play roulette with their health, sometimes the only medicine is hoping for the best.
“You just take your chance. Literally. I’ve been lucky….so far.”
(This story was originally published on Feb. 21, 2020)