New Mexico and Virginia Pass Limits on Insulin Copays

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Bottle of insulin -- New Mexico and Virginia Pass Limits on Insulin Copays

During this time of fear and uncertainty around the world for people with diabetes due to the COVID-19 pandemic, it can be easy to miss good news. But residents of two U.S. states who take insulin for their diabetes may have a reason to celebrate in the near future: their state legislatures have recently passed bills putting a cap on out-of-pocket costs for insulin.

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In both New Mexico and Virginia, lawmakers limited how much insurance companies can charge customers in out-of-pocket costs for a month’s supply of insulin. These states follow two others — Colorado and Illinois — in passing caps on out-of-pocket insulin costs within the last few months. But the caps in both states are even lower than in Colorado or Illinois, both of which set the limit at $100.

New Mexico governor signs law capping insulin copays

On March 4, Governor Michelle Lujan Grisham of New Mexico signed into law a bill that limits out-of-pocket costs for a 30-day supply of insulin to $25. It passed both houses of the state legislature nearly unanimously, with a House vote of 61–2 and a Senate vote of 40–1.

“I am proud to have sponsored House Bill 292 making sure all New Mexicans can afford the medicine they need to survive and thrive,” said state Rep. Micaela Cadena in a press release by the governor’s office. “Capping insulin copays is an effort to bring much-needed relief to families facing unconscionably high drug prices.”

“This law ends an unacceptable dilemma for thousands of New Mexicans with diabetes forced to choose between life-saving insulin and other expenses,” added Gov. Grisham in the statement.

The New Mexico law also requires the New Mexico Department of Insurance to issue a report summarizing insulin pricing practices in the state, along with recommendations to make sure insulin isn’t overpriced, as noted in a Healio article. This provision is meant to ensure that insurance companies aren’t facing outrageous insulin prices, which they would then most likely pass along to all their customers in the form of higher premiums.

Virginia Legislature send bill capping insulin costs to governor’s desk

Soon after New Mexico’s new cap on insulin copays became law, the Virginia General Assembly passed a bill that limits out-of-pocket insulin costs to $50 a month. That’s higher than the bill’s original author, Del. Lee Carter, wanted. But Carter urged his colleagues in the House to accept a Senate amendment to the bill that raised the limit from $30 to $50, in the interest of getting it passed, according to an article in the Prince William Times.

“This is aimed at providing relief for folks who have health insurance but still can’t afford their medication,” the article quotes Carter as saying during a committee hearing on the bill. “And with Medicaid expansion, that’s going to cover a vast swath of Virginia’s population that otherwise couldn’t afford insulin,” Carter continues.

The cap in the Virginia bill applies to all monthly out-of-pocket expenses for insulin, including both deductibles and copays. The bill received support from the Medical Society of Virginia and AARP, but was opposed by the Virginia Association of Health Plans, which claimed that any savings seen by people who use insulin would come at the expense of higher premiums for everyone.

During hearings on the bill, one state lawmaker pointed to news reports last year of a Virginia man with type 1 diabetes who died after switching to a lower-cost insulin in an attempt to save up money for his wedding. The brand he had originally been prescribed cost $1,200 per month, while the generic insulin he switched to cost about one-tenth as much. The man’s fiancée found him in a coma at the dog kennel where he worked.

The Virginia bill now goes to the desk of Gov. Ralph Northam, who is expected to sign it into law.

Want to learn more about saving money on insulin? Read “Sanofi Offering Insulin at $99 Per Month,” “Half-Price Humalog Insulin Now Available,” “Insulin Prices: Four Ways to Pay Less” and “Cheaper Insulin: Older Insulins May Be Answer to High Prices.”

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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