Health Policy Commission Report Confirms Insulin Out of Reach for Many Diabetics in the State; Health Care For All Urges the Legislature to Address the Issue of Prescription Drug Costs

Wednesday, May 8, 2019
Thursday, May 2nd 2019

Yesterday, the Health Policy Commission (HPC) issued the results of a case study looking at the price of insulin and its impact on individuals with diabetes in the Commonwealth. "HPC DataPoints, Issue 11: Insulin Price Growth and Patient Out-of-Pocket Spending" analyzes spending trends from 2013 to 2016 for commercially insured patients who have diabetes and use insulin to manage their condition.

The report highlights that between 2013 and 2016 annual health care spending for individuals dependent on insulin to control their blood sugar levels increased by $4,016 (31 percent). By 2016, spending on insulin represented the largest component of total health care spending for this population, accounting for 39 percent of the total spending increase. In fact, according to the HPC, annual spending on insulin for this population increased by 50 percent - from $3,122 in 2013 to $4,684 in 2016.

This compilation of data also points to consumer affordability and access threats due to the rising costs of managing diabetes. One recent national study published in January 2019 found that one quarter of patients reported using less insulin than prescribed due to high costs.

"I currently have very good health insurance through my employer, but if my job were to ever go under or I'm ever switched to a high deductible plan the timer will start ticking until my insulin stock pile runs out and I will be faced with the painful decision of either having to leave the country, find more donated insulin from friends and family, or start a go-fund me account like thousands of my peers are doing right now in an effort to stay alive," said Chris Noble, a Cambridge resident who has been dependent on insulin to control his diabetes for 24 years.

"This report is further evidence that it is time to bring down the high cost of prescription drugs. Currently, there is little to no transparency when it comes to the black box of prescription drug pricing, and no accountability mechanism to ensure that drugs are affordable for those who need them," said Amy Rosenthal, executive director of Health Care For All. "Consumers, business leaders, insurers, hospitals and providers have made significant sacrifices to address access and affordability issues. Pharmaceutical companies have not put any skin in the game thus far, and it is time for them to do their fair share."

The Massachusetts legislature is currently considering comprehensive legislation to address this important issue that is putting life-saving drugs out of reach for many residents. An Act to ensure prescription drug cost transparency and affordability (H. 1133/S. 706), sponsored by Senator Jason Lewis and Representative Christine Barber, aims to make prescription drugs more affordable and available to consumers, ensure pharmaceutical costs are more transparent, and contain costs for MassHealth, employers, and across the entire health care system.

"Health Care For All supports this legislation because a comprehensive approach is needed to address the challenge of high and rising prescription drug costs in the Commonwealth. This bill both improves transparency throughout the drug pricing process and brings accountability to the public and private system so that prescription drugs are more affordable for patients such as Chris," added Rosenthal.

This legislation includes six policies that address factors driving up prescription drug costs. It provides transparency around the underlying costs to produce prescription drugs; restrains abuses of pharmacy benefit managers; authorizes the HPC to set upper payment limits to bring down the costs of unreasonably high-priced drugs; requires pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using health insurance; provides tools to strengthen MassHealth's ability to negotiate lower drug prices; and permanently funds a program to provide evidence-based information to providers known as "academic detailing."

A broad-based coalition of groups representing consumers, seniors, children, providers and faith-based groups have come together to support H. 1133/S. 706.