In June 2019, Lija Greenside handed Minnesota Governor Tim Walz an empty insulin bottle that her 13-year-old daughter had painted gold.
Greenseed’s daughter has type 1 diabetes and requires daily injections of manufactured insulin to survive. The price of a bottle of insulin has increased by about 1,200% between 1996 and 2018, but the gold bottle is a reminder that this life-saving medicine shouldn’t be as expensive as precious metals, Greenside said. spoke.
“The story I heard was that the vial of gold remained on the governor’s desk in the governor’s office, and that he brought it up over the summer and fall when he was talking to members of Congress and mobilizing them. That’s true,” Greenside said.
Ten months later, in April 2020, Walz signed Alec Smith’s Insulin Affordability Act into law. The law, named after a 26-year-old Minnesotan who died from insulin rationing in 2017, helped patient advocates turn America’s high insulin prices into a national political priority.
This is now an issue in the presidential election. Former President Donald Trump and Vice President Kamala Harris, as well as running mate Walz, have all promoted policies that would make insulin cheaper for some patients, including the nation’s 8.4 million insulin users and their allies. I’ve been trying to appeal to my family.
But advocates for diabetes patients argue that neither of the two until Walz’s Minnesota law, which provides relief to uninsured patients, even though the law is under legal attack from the pharmaceutical industry. I am concerned that presidential candidates will not step in.
The insulin pricing landscape has already changed significantly over the past five years. A month after Walz signed the Minnesota law, the Trump administration announced a voluntary program for Medicare prescription drug plans that would cap copays on some insulin products at $35. Two years later, President Joe Biden signed legislation requiring all Medicare drug plans to cap copays for insulin at $35 per month.
During the current presidential campaign, Harris proposed expanding the $35 co-pay cap on insulin for Americans with commercial health insurance.
The Trump campaign’s national press secretary, Caroline Leavitt, highlighted her efforts on prescription drug prices while in the White House, including approving a prescription drug import route from Canada and approving a voluntary $35 Medicare copay cap for insulin. was advertised. But she did not propose any new insulin-specific efforts for a possible second term as president.
“President Trump will finish what he started in his first term,” Levitt said in a statement.
Out-of-pocket caps, which have been enacted in 25 states, are popular policies because they provide an immediate financial benefit to many patients when they go to the pharmacy, said Neeraj Sood, an economist at the University of Southern California. It has become. It’s also relatively easy to implement.
But copay caps do not address the high list price of insulin itself, so uninsured patients cannot benefit from such rules. Last year, about 1 in 12 Americans did not have health insurance.
That’s what makes Minnesota’s insulin safety net different. This system has two parts. One is an emergency program that allows individuals to receive a one-time 30-day supply of insulin for $35, and the other is a continuing program that provides one year of insulin to eligible patients for $50 or less for $90. is. -Daily supply.
In contrast, the list price for a 30-day supply of insulin can easily exceed $215, depending on the insulin.
The bill that created Minnesota’s program was necessarily bipartisan. At the time, Republicans controlled the state Senate, and the Minnesota Democratic-Farmer-Labor Party controlled the House of Representatives and the governor’s office.
Nicole Smith-Holt, whose son the bill is named after, tearfully watched the bill finally pass the state House in 2020.
“I was happy. I was relieved,” Smith-Holt said. “It’s a shame that it took Alec’s death before people could go to a pharmacy and pick up their prescriptions at an affordable price.”
But Minnesota’s program requires insulin manufacturers to provide insulin, prompting pushback from manufacturers. In 2020, the pharmaceutical industry lobby group PhRMA called the Minnesota law a violation of the U.S. Constitution’s Expropriation Clause, which states that private property cannot be taken for public use “without just compensation.” filed a lawsuit to prevent it.
While the lawsuit is still ongoing, the national program is up and running and has been used more than 1,500 times by the end of 2023.
Reed Porter, a PhRMA spokesperson, said his group is committed to helping patients afford their medicines. Insulin makers voluntarily lowered their list prices last year and are now offering patient assistance programs to help them buy the drug. And it was the CEO of insulin maker Eli Lilly who first proposed the Medicare out-of-pocket cap that President Trump announced in 2020.
Porter said insurance companies and pharmacy benefit managers, also known as PBMs (intermediaries between insurance plans and employers and drug companies), obtained discounts from drug list prices negotiated with manufacturers. As a result, the cost of insulin is rising.
“Minnesota’s insulin program does not solve this problem and is unconstitutional,” Porter said. “This is not the way the system should be, and why it is important that policymakers prioritize reforming the PBM system, a solution that prioritizes patient health over politics.”
In 2021, Sood revealed that even though the list price of insulin increased from 2014 to 2018, the revenue received by pharmaceutical companies decreased while the revenue received by intermediaries such as PBMs and pharmacies increased. co-authored a study on
In September, the Federal Trade Commission announced a lawsuit against the nation’s three largest PBMs, accusing them of creating a system to inflate insulin prices. Both companies denied the allegations.
Jing Luo, an internist at the University of Pittsburgh, said no matter who wins in November, with support from Smith-Holt, Smith-Holt and others, existing measures such as Medicare’s general out-of-pocket caps will change. He said he does not expect the insulin policy to be reversed. green seed.
“They were very effective in linking high insulin prices to morally repugnant outcomes,” Luo said.
The key for Minnesota was to include a true story, Greenside said.
“We had enough real people to reach out and have a conversation and help us demonstrate to politicians the seriousness of the problem, and they listened,” Greenside said. he said.
brams@kff.org, @besables