Out-of-pocket costs would be capped at $100 for 30-day supply
By PETER HANCOCK
Capitol News Illinois
SPRINGFIELD – Many Illinoisans who suffer from Type 1 diabetes would see a significant reduction in their out-of-pocket costs for prescription insulin under a bill that cleared the state Senate on Tuesday.
An amendment to Senate Bill 667, sponsored by Sen. Andy Manar, D-Bunker Hill, would cap the price for a 30-day supply of insulin at $100 for people covered under certain kinds of insurance policies. The bill also directs the attorney general to investigate why insulin prices have been rising sharply in recent years.
“Illinois families deserve to have the peace of mind that comes with knowing their loved ones do not have to choose between putting food on the table and buying their prescription medication,” Manar said in a statement after the Senate vote. “The Senate just took a step toward making that a reality.”
On the Senate floor, Manar spoke of one constituent he represents who pays more than $500 a month for insulin.
The bill would apply only to insurance plans that are regulated by the state. Those generally include plans offered by small employers, as well as public plans like the state employee health program. It would not apply to plans offered by large employers that are governed by the federal Employee Retirement Income Security Act, or ERISA, which account for the vast majority of insurance policies in Illinois.
The bill also would not limit how much drug companies can charge for insulin. Rather, it would force insurance companies that would be covered by the new law to pick up a larger share of the cost.
The pharmaceutical industry has argued that all insulin manufacturers in the United States also offer cost-sharing assistance, known as copay cards or coupons, that can greatly reduce out-of-pocket costs for many patients. Some of those are offered in partnership with the American Diabetes Association.
Sen. Dave Syverson, R-Rockford, said he felt frustrated that more isn’t being done to promote those programs.
“For small employers, the cost of health care is what's driving so many of them to either drop costs or pass costs on,” he argued. “And right now, in this population, you have a small number of people that have high-deductible plans, and there are programs available through the Diabetes Association that'll pay those copays for them. And what we're going to do with this legislation is we're going to take the drug companies out of the equation, and instead we're going to make the insurance companies now pick up all the costs over $100.”
Manar, however, said those discount programs don’t go far enough to address the issue.
“The problem that families are facing every day in the state is not because of a lack of pamphlets on how to access a program to assist them in paying for insulin,” he said.
The bill passed by a vote of 48-7. It now moves to the House.