Insulin Copay

Posted : admin On 1/3/2022
  • To address the immediate needs of West Virginians with diabetes during the current coronavirus pandemic, the ADA has urged Governor Justice to eliminate all cost-sharing for insulin in state-regulated health insurance plans and revert to the $100 copay cap when the crisis passes. The ADA also urged Governor Justice to ensure continuous access to health care for residents with diabetes who have lost.
  • Lilly may be able to help those patients who are not eligible for a BASAGLAR Savings Card or need additional assistance. Call the Lilly Diabetes Solution Center at 1-833-808-1234. Lilly is committed to helping people with diabetes regardless of whether they have insurance from an employer, Medicare, or no insurance at all.
  • Five other states – Connecticut, Florida, Kentucky, Tennessee, and Virginia – have advanced legislation regarding insulin copay caps and are awaiting a final verdict. Each of these states’ proposed bills cap insulin copays at $100 per month, with the exception of Connecticut, which limits out-of-pocket insulin expenses to $50 per month.

Another long-acting insulin from Novo Nordisk

OKLAHOMA CITY (KOKH) - Legislation helping Oklahomans with diabetes better afford insulin has become law after being signed by Gov. Stitt on Tuesday. House Bill 1019 caps the copay for a 30-day.

Tresiba® has similar national formulary coverage to Levemir®, including Medicare Part D plans, and a co-pay card offer.

Formulary coverage

Insulin Copay

Levemir® is available on ~87% of Commercial and Medicare Part D plans1,a
The formulary tool lets you quickly scan Levemir® coverage for various health plans in your area.b

Insulin Copay Help

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aFormulary Data Source: Fingertip Formulary; June 30, 2020. Due to rounding, numbers may not add up to 100%.

Insulin Copay Cap Virginia

bFormulary status is believed to be accurate at the time of update but cannot be guaranteed.

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Find out if your patient’s insurance plan covers Levemir® and calculate their co-pay. Your patient’s pharmacy prescription card information may be needed.
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Patients who are approved for the PAP qualify to receive free diabetes medicine from Novo Nordisk, including Levemir®, for up to a year.

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Eight States Pass Legislation to Place Caps on Insulin Price; Five More Await Ruling

While the coronavirus epidemic has brought federal drug pricing reform to a halt, individual states have been busy enacting their own drug pricing legislation.

In just the past six weeks, six states have passed laws that cap insulin copayments at or under $100 per month: Maine, New Mexico, New York, Utah, Washington, and West Virginia. These states now join two others, Colorado and Illinois, in becoming the first states to legislate on insulin affordability.

States That Have Passed an Insulin Price Cap

State

Legislation

Date Effective

Date Signed

Colorado

$100 cap for 30-day supply

January 1, 2020

May 22, 2019

Illinois

$100 cap for 30-day supply

January 1, 2021

January 2020

Maine

$35 cap for 30-day supply

January 1, 2021

March 31, 2020

New Mexico

$25 cap for 30-day supply

January 1, 2021

March 4, 2020

New York

$100 cap for 30-day supply (for state-regulated commercial plans)

January 1, 2021

April 3, 2020

Utah

$30 cap for 30-day supply

January 1, 2021

March 30, 2020

Washington

$100 cap for 30-day supply

January 1, 2021

March 31, 2020

West Virginia

$100 cap for 30-day supply

July 1, 2021

March 6, 2020

Colorado’s law has also revealed a few loopholes. Some health plans fell into an exemption in the legislation, leaving the people on those health plans ineligible for the insulin price cap when purchasing their monthly insulin. Additionally, instead of offering a flat $100 maximum on monthly insulin prescriptions, the current legislation allows insurers to charge $100 per prescription per month, which translates to $200 for those who take both basal and mealtime insulin or two other insulins, such as short-acting and long-acting. In the US, Colorado was the first state to pass its insulin price cap in 2019, and it is the only state in which the law has gone into effect. Due to regulations around health plan renewals, the other seven states must wait until 2021 for these laws to take effect.

While we must wait to see how the other insulin price caps will play out in 2021, there are some positive developments. For example, in addition to its $30 copay cap, Utah’s legislature approved allowing pharmacists to refill expired prescriptions on an emergency basis, thus removing a barrier for those in dire situations. Additionally, in some states, including Colorado, Illinois, and New Mexico, the legislation requires the states to produce a report on insulin pricing practices and provides public policy recommendations to increase affordability.

Five other states – Connecticut, Florida, Kentucky, Tennessee, and Virginia – have advanced legislation regarding insulin copay caps and are awaiting a final verdict. Each of these states’ proposed bills cap insulin copays at $100 per month, with the exception of Connecticut, which limits out-of-pocket insulin expenses to $50 per month.

Additionally, this new wave of state insulin caps parallels Medicare’s recent pilot program that caps monthly insulin costs at $35.

Insulin Copay Assistance

While these insulin price caps are much needed, they generally only apply to people with private/commercial insurance. Those who are uninsured should work to use patient access programs, most of which now give insulin at the same price as state levels or lower, assuming they are approved for the patient. We hope government programs change and become open to those on Medicare since those on Medicare have fewer programs available for them, per government regulations.

As unemployment has soared during the COVID-19 epidemic and people lose insurance through their employers, it is critical for lawmakers to further this work on ensuring that insulin is affordable for all who need it. Until then, some people may be able to find savings through patient assistance programs and copay savings cards. To learn more, see our Get Insulin resource page.

Insulin Copay Relief Program

By Karena Yan