Cops and Courts, Energy, Healthcare, West Virginia Legislature

Senate insulin copay cap bill sparks long House debate, citing fears of premium hikes

MORGANTOWN – The House of Delegates spent nearly an hour debating the Senate bill to cap the copay for insulin and devices for patients with diabetes.

Opponents foresee unintended economic consequences. Both sides drew on personal stories of people living with diabetes and other diseases requiring high-price treatments to make their case.

SB 577 reduces the copay cap of a 30-day supply of insulin from $100 to $35, and sets a $100 cap for devices (a blood glucose test strip, glucose monitor, lancet, lancing device, or insulin syringe; but not insulin pumps). The cost-sharing maximums are aggregate, regardless of quantity or type. A prescription would not be required to obtain a blood-testing kit for ketones.

As it came from the Senate, the bill covered only private insurance and left out PEIA. Delegates adopted a House Health amendment to include PEIA.

Delegate Jim Butler, R-Mason, led off the opposition, saying the bill has great intentions but he doesn’t know if it’s necessary. He referred to Eli Lilly’s Wednesday announcement that it is reducing the prices for its most commonly prescribed insulins by 70% and expanding its Insulin Value Program that caps patient copays at $35 or less per month.

“The free market is already working,” Butler said. And government-mandated caps will just lead to cost-shifting, where companies charge more elsewhere and insurers raise premiums.

Cost-shifting was a common theme among opponents. Delegate Laura Kimble, R-Harrison, said, “There will be a butterfly effect for some and there will be a tyrannosaurus rex effect for others. … Nothing comes without a price.”

Delegate Anita Hall, R-McDowell, said she lost her father-in-law to diabetes. But her mother-in-law pays $600 a month for a medication she needs for a different disease. She has children and grandchildren with genetic diseases that require weekly shots costing more than $3,000 each.

“I stay awake at night worrying about unintentional consequences,” she said. “I do not want to take the risk of helping one at the detriment of another. … Although it is a hard vote for me, I will be voting no.”

Unintended consequences was another common theme. Delegate Bill Ridenour, R-Jefferson, said, “Even if we are trying to do something good, we usually end up doing some negative harm someplace else. … Those rate increases are going to cost West Virginians their insurance.”

Bill supporters often cited the low production cost of insulin and the huge profits – even at $35 per month. Singlecare cited a 2018 study that estimated that one vial of human insulin costs $2.28-$3.42 to produce, and one vial of analog insulin costs $3.69-$6.16 to produce.

Delegate Joe Ellington, a physician, said his son needed his insulin refilled a week before it was eligible for renewal under their PEIA plan, and had to pay $600 to bridge that week. Type 1 diabetics can die without their insulin.

Delegate Shawn Fluharty, D-Ohio, said, “Imagine being from West Virginia and arguing Big Pharma needs more money.” Lilly made $24.5 billion last year, meanwhile Americans have to go to Canada to get affordable medications.

Delegate Ric Griffith, D-Wayne, said this bill is the start of a process to put pressure on companies to not overcharge. Other insulin makers will fall in line with Lily. “This bill is not only well intended, it’s critical for many West Virginians who are struggling to say alive and treat a condition that has no forgiveness.”

Some delegates in the medical profession talked about the consequences of failing to treat diabetes – along with death people can lose limbs or end up on ventilators in ICUs. Along with lives, those consequences have economic costs.

Others picked up on the theme of insulin being cheaper in Canada and other countries. Delegate Daniel Linville, R-Cabell, said that’s tied to U.S. patent protections, which foster research and development but still enable patent holders to sell drugs cheaper everywhere else.

“That’s ridiculous,” he said. The Legislature needs to work with federal lawmakers on that problem. “No drug should be any less expensive, not one dime, anywhere else in the world if you’ve got patent protection in the United States, starting with insulin.”

Delegate Sean Hornbuckle, D-Cabell, summed up the proponents’ view: “This is not an economic debate, it’s a life debate.”

As often happens in the House, the vote didn’t reflect the length of the debate. SB 577 passed 85-12 and returns to the Senate for amendment concurrence. All the votes against came from Republicans.

Other bill action

SB 188 is the Grid Stabilization and Security Act, for the state to promote gas-fired power plant projects through identification of viable sites and expedited permitting. Delegates spent about 45 minutes on Thursday debating and defeating a proposed amendment to do the same for coal-fired plants. On Friday it passed 90-5 with no debate – with four Democrats and one Republican voting no – and returns to the Senate for concurrence on a different amendment.

SB 490 is the SB 490 Patrol Officer Cassie Marie Johnson Memorial Act, named for Charleston Police Officer Cassie Johnson, who was fatally wounded in 2020 while responding to a routine parking complaint..

The House adopted an amendment adding some words to the Senate version. It now says anyone who “knowingly, willfully, and forcibly obstructs or hinders a law-enforcement officer, probation officer, parole officer, courthouse security officer, correctional officer, the State Fire Marshal, a deputy or assistant fire marshal, firefighter, or emergency medical service personnel” acting in their official capacity and causes their death is guilty of a felony and subject to 15 years to life in prison.

Following the unanimous vote to pass it, delegates held a moment of silence for Johnson and her mother, who was watching in the gallery. It returns to the Senate for amendment concurrence.

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