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For patients with insulin-dependent diabetes, the medication isn’t optional. They need it to live.
But soaring insulin prices, along with the expense of related supplies like syringes and test strips, have left too many patients struggling to afford this life-saving drug. Skipping the medication or reducing the dose and hoping to survive the consequences â€" a type of life-and-limb roulette â€" is a real choice some are forced to make.
House Bill 292, introduced by Sen. Daniel Ivey-Soto, D-Albuquerque, and Rep. Micaela Lara Cadena, D-Mesilla, would address at least part of the problem by capping at $50 a month the out-of-pocket expense patients covered by private health insurance would have to pay for insulin and related supplies.
“Under this legislation, New Mexicans with diabetes will no long have to choose between medication and other necessities,†Gov. Michelle Lujan Grisham said. “This is an unconscionable choice no one should ever have to make.â€
................................................................True enough. An estimated 14% of New Mexicans have diabetes, according to the American Diabetes Association, and diabetes and pre-diabetes in the state rack up an estimated $2 billion in costs a year.
So this bill should be approved and signed into law.
But it is a Band-Aid that covers only part of the wound, and it has other ramifications.
Number one is the bottom line. Proponents simply say health insurance companies will cover the cost. The key is how â€" the cost is inevitably spread to other people covered by the plan in the form of higher premiums, larger deductibles, bigger co-pays or a combination thereof. There is no free lunch, and anyone with private health coverage is already feeling the pain.
It’s also worth noting this is an unfunded mandate â€" the state isn’t putting anything in the game upfront, though it picks up the full tab for people covered by Medicaid. On the plus side of this equation, making insulin readily available at a lower price should help keep patients out of emergency rooms and thereby save money for government and private health insurance companies.
Second, the cap does nothing for people without health insurance. They remain stuck with high costs and tough choices. Also, it’s not clear how it would apply to people covered by plans subject to federal regulation for price caps, such as Medicare or Tricare.
Third, while people with diabetes need insulin â€" cardiologist Kevin Campbell writes in U.S. News and World report that roughly 10% of Americans suffer from diabetes â€" many patients need other life-saving drugs that have seen huge price increases, including cardiac, respiratory and cancer medications. They also are being forced to make what the governor calls unconscionable choices.
It’s easy to blame drug companies for the increases in insulin prices, which nearly tripled from 2002 through 2013 and have gone up 10 percent a year since then. Indeed, profit motive and greed by the pharmaceutical industry, which has extended patents repeatedly, is a factor.
But it’s also more complicated. Insulin is a biologic compound that can be difficult and expensive to produce, with most of it made by using recombinant DNA techniques. FDA regulations make it costly to produce generic or biosimilar medications when dealing with biologic compounds. While possible, drug makers have little incentive to spend millions of dollars to develop a cheaper alternative.
While other states are also instituting out-of-pocket caps, this bill doesn’t fix the larger problem of out-of-pocket expense for drugs. However, the bill does require the Superintendent of Insurance to study the affordability of other drugs.
While we can bash drug companies for their profits, in the same breath we have to thank them for the life-saving products their innovation and investment provides. Although one could argue HB 292 is a case of the Legislature deciding who deserves to live and who doesn’t, this important legislation will save lives, and it’s a start.
This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.
