House passes SB-577 to cap copays on insulin; Legislation returns to the Senate

AARP-WV sees support for the legislation, hopes to see it reach the Governor

By Matt Young, WV Press Association

CHARLESTON, W.Va. — West Virginia took another big step toward lowering its cap on copays for insulin and other diabetic-devices on Friday, with the House of Delegates passage of Senate Bill (SB) 577. 

Addressing SB 577, Gaylene Miller, state director for AARP-WV, said, “There has been really good support for the idea of reducing the copay cap on insulin.” AARP WV has been one of the main proponents of the legislation.

Gaylene Miller.

Miller noted that similar legislation was proposed last year, but “didn’t make it across the finish line.”

“This year, we are cautiously optimistic that it’s going to make it across that finish line to the governor’s desk, and get signed,” Miller added. 

SB 577 seeks to reduce the insulin copay cap, from the current limit of $100 to $35. Insulin delivery devices would also be covered by a $100 copay cap. In addition, the bill allows for the purchase of diabetes testing equipment without a doctor’s prescription. SB 577 was passed in the Senate on Feb. 23 by a vote of 32 to two. 

“Addressing the high cost of prescription drugs has been a priority of AARP for my entire career, and I’ve been with AARP for more than 20 years,” Miller said. “It’s an ongoing issue that we’ve tried to address.”

“It’s sort of like the old adage, ‘How do you eat an elephant?’” Miller noted. “One bite at a time.”

Despite the legislation’s failure to make it to the governor’s desk in 2022, Miller remained committed to its necessity.

Miller’s first “bite” of the 2023 legislative session came on Jan. 19, while testifying before the House Committee on Senior, Children and Family Issues. When referencing a recent AARP member-survey, Miller told the committee, “Nearly 70% of our survey respondents want lawmakers to take action to lower the cost of insulin, and other prescription drugs, during this year’s session.”

As explained in the text of the bill: “It is estimated that over 240,000 West Virginians are diagnosed and living with type 1 or type 2 diabetes and another 65,000 are undiagnosed. The medical cost related to diabetes in West Virginia is estimated at $2.5 billion annually.”

SB 577 further explains that the costs associated with insulin and other diabetic equipment and supplies, as well as the cost of insurance copays, has “increased astronomically.” The bill estimates that West Virginians living with type 1 or type 2 diabetes have a monthly out-of-pocket expense “in excess of $1,000.”

“I believe it was in 2020 our state passed a prescription drug transparency law thinking that if pharmaceutical companies had to provide information about why they were raising their costs, perhaps that bit of accountability would make them think twice,” Miller said. “That’s up and running in our state now, and we’re really proud that we have that continuing focus on transparency.”

“Lowering out-of-pocket costs is a big deal,” Miller continued. “Increasing access and affordability is something that AARP has been advocating for for a number of years. We were pleased to see the federal government to take the first step and lower or cap copays for insulin for Medicare beneficiaries. That’s a significant part of the population, but certainly not all diabetics are covered by Medicare.”

“We know that – at least in West Virginia – 20% of the market has private insurance,” Miller noted. “So, that’s what this bill (SB 577) is intended to address. It puts a cap on copays for folks who are on private insurance.”

Miller also noted that pharmaceutical manufacturer Eli Lilly and Company, on Friday, announced that they would be implementing a $35 copay cap for insulin, before adding, “That’s welcome news, but they’re not the only manufacturer of insulin.”

“But I also think it’s a signal that lots of states are passing these copay caps and I think it’s putting pressure on the manufacturers to do something about it,” Miller noted. “There are 23 states that have a cap on insulin for copays. West Virginia is one of them, but right now our cap is one of the highest in the country.”

SB 577 was returned to the Senate for consideration. 

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