Colorado is the first state to announce legislation to cap insulin prices! While this is an awesome step, it rubs me the wrong way. This legislation only impacts people with insurance. This is the actual wording of the law:

A CARRIER THAT PROVIDES COVERAGE FOR PRESCRIPTION INSULIN DRUGS PURSUANT TO THE TERMS OF A HEALTH COVERAGE PLAN THE CARRIER OFFERS SHALL CAP THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO PAY FOR A COVERED PRESCRIPTION INSULIN DRUG AT AN AMOUNT NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY OF INSULIN, REGARDLESS OF THE AMOUNT OR TYPE OF INSULIN NEEDED TO FILL THE COVERED PERSON’S PRESCRIPTION.

I understand that those with high deductible plans are paying somewhat higher prices, but for most plans even prior to the deductible being satisfied, there is a preferred formulary with discounted prices. My frustration lies in the fact that it just creates another layer of insurance shell games, but doesn’t address the real problem which is the RIDICULOUS price of insulin for anyone, insured or not. It cost’s less than $10 to produce, manufacture and distribute insulin according to a Harvard Study. And there is amply research to show that price-fixing has occurred between the manufacturers. Unfortunately, they are doing nothing wrong, because, as it stands, it is legal for drug companies and insurance companies to keep this process hidden.

Who Makes These Laws?

I have been a consumer of healthcare billing rules and regulations for almost 20 years. I don’t profess to be an expert, but I do know that most private carriers follow CMS (Medicare & Medicaid) policies. Over the years, as CMS has instituted DRG payment systems, set regulations for billing of procedures and services (CPT codes) and implemented PPOs and other payment systems, all the large carriers follow suit. CMS creates the rules, insurance companies work within those rules to establish their policies. Perhaps if our government-regulated itself/CMS a bit more, the insurance companies wouldn’t have the freedom to create these back door deals with drug companies.

It makes great headlines to say you have capped insulin at $100/month, and super for those whose insurance plans will benefit.. But, if you own a small business or don’t have a corporate policy, you are still paying FULL PRICE. Which is over $200 a vial for something that costs $10. It makes my blood boil! But we have options. I refuse to pay these prices. Message me if you need info!

I am thrilled that people are talking about this issue, but let’s not get ahead of ourselves. We have a long way to go!

#Rantover

Peace and patience!

Patricia