Healthcare, Latest News, West Virginia Legislature

Senate Health Committee raises insulin bill copay cap from $25 to $100

MORGANTOWN — The House bill to cap insulin copay for diabetes patients escaped death in the Senate on Monday and came through Senate Health on Tuesday with one significant change: The copay cap for a 30-day supply rose from $25 to $100, matching a couple of the other insulin bills that were introduced.

HB 4543 passed the House 94-4 on Feb. 19. It reached then Senate the next day and was double-referenced to Banking & Insurance and then Finance.

However, according to reports, it sat idle and doomed in Banking & Insurance because the committee chair, Sen. Mike Azinger, R-Wood, opposed it and had no plans to place it on an agenda.

But bill supporters, including the West Virginia Team for Insulin Affordability, lobbied and pressured; so Azinger at the last moment placed it on his agenda for the panel’s last meeting on Monday. (The bill doesn’t appear on published agendas but word got around.)

HB 4543 had bipartisan sponsorship in the House: seven Republicans, four Democrats. Four sponsors are local: Barbara Evans Fleischauer, Buck Jennings, Amy Summers and Michael Angelucci.

It notes in its findings that more than 240,000 West Virginians are diagnosed with diabetes. A patient’s insurance copays and out-of-pocket expenses can exceed $1,600 a month. This leads many to ration or do without their medicine, leading to comas, strokes and death.

As it came out of the House and reached Banking & Insurance the bill limited cost sharing at the point of sale for patients with private insurance and PEIA to $30 for a 30-day supply.

In Banking & Insurance, Matt Walker, representing the West Virginia Independent Pharmacy Association and the West Virginia Primary Care Association, fielded questions about how the costs would be shifted if the bill passes.

He said that in the complex pharmaceuticals chain, pharmacy benefit managers (PBMs) and insurers can use such things as “calwbacks” and reimbursement cuts to reduce payments to pharmacies even after the insulin is sold and left the building. This can lead the pharmacy to pay the PBM more than it received for the insulin.

He said his group hoped to see some hold-harmless language added to the bill.

Meanwhile, HB 4543 had acquired yet another committee reference, to Senate Health. So the committee chose to pass the bill along to Health without any recommendation for passage, and let stakeholders and Health staff tweak the bill to deal with the pharmacy question and some others that weren’t discussed at the meeting.

So Health took up a version that raised the cost-sharing cap to $100 and protected pharmacies from absorbing the lost revenue.

Health vice-chair Eric Tarr, R-Putnam, talked more about cost shifting. Along with the PBM tactics Walker mentioned, Tarr said the industry will recover costs by raising insurance premiums, by altering provider contracts to require more services without increasing reimbursements, or simply charge more for other products.

“This is poking a balloon,” he said. You hold one spot firm, another spot bulges.

Nancy Tyler, a former House of Delegates staff attorney who has had Type I diabetes for 65 years, addressed the committee. She pointed out that the bill does nothing for the uninsured.

But the insurance industry won’t suffer by paying more to the PBMs and pharmacies, she said. That’s because they’ll be paying less for the consequences of covering expensive medical care and hospital stays for those who now go without their insulin. Colorado is one of two states that have insulin cost-sharing caps, she said, and a full year after its went into effect, the industry hadn’t complained because it was seeing those offsets.

Senate Health passed the bill unanimously in a voice vote and sent it on to Finance, which will likely review a PEIA fiscal note that says the bill could affect manufacturer rebates and cost PEIA another $900,000 per year.

Tweet David Beard @dbeardtdp Email