A road map for lowering insulin costs in Washington

Washington should make insulin more widely available at cheaper prices and offer a free 30-day supply at least once a year for people who are short on the drug and can’t afford it.

That’s the message delivered to state lawmakers from a workgroup assigned to chart a course to increase insulin access and affordability. Hundreds of thousands of Washington residents with diabetes depend on insulin every day.

To lower costs, members recommend a long-term strategy for the state to expand a drug rebate program and contract directly with manufacturers to sell insulin at lower prices.

In the short term, they want Washington to follow other states and require manufacturers to cover the cost of a 30-day supply of insulin for people who need it urgently.

“This policy has been effective in Maine and Minnesota since the cost of insulin is often the greatest barrier that patients face when needing an emergency supply,” members of the Total Cost of Insulin Work Group wrote in their final report posted online in July.

Diabetes, which refers to a group of diseases related to harmfully high blood glucose, is a chronic condition without a cure. People with Type 1 diabetes must use insulin regularly, through daily injections or an insulin pump, to stay alive.

The disease contributed to more than 125,000 hospitalizations and 6,046 deaths in Washington in 2017, according to the most recent Diabetes Epidemic & Action Report released in December 2019. That analysis estimated that 682,000 adults and 2,970 youth under the age of 18 had been diagnosed with some type of diabetes.

In recent years, the state Legislature has addressed insulin expenses which can vary greatly by product type and manufacturer as well as a patient’s insurance coverage and treatment. 

In 2020, legislators capped the out-of-pocket costs for insulin at $100 for a 30-day supply. Two years later, they reduced the cap to $35 and, earlier this year, Gov. Jay Inslee signed a bill to make that limit permanent. 

Meanwhile, a 2022 law directed the work group “to review and design strategies to reduce the cost of and total expenditures on insulin in the state.” 

Urgent need for action

In its report, the work group outlined a three-pronged approach to provide insulin at discounted costs.

One step is ensuring patients know discounted prices on insulin products are now available for those with an ArrayRx discount card. This program offers card-holders a discount on certain prescription drugs.

Second, an ArrayRx voucher program specific for insulin could be created to provide greater discounts. This envisions the state negotiating directly with manufacturers to supply insulin products at a lower rate.

Under this scenario, pharmacies would get the full price. Patients would pay a predetermined portion of that cost, while the state would cover the remainder. Manufacturers would then reimburse the state in the form of a rebate.

A third idea is for the state to have manufacturers operate a patient assistance program which would offer a no-cost option for patients with a family income under a specific threshold. 

The work group drew heavily from Minnesota’s Alec Smith Insulin Affordability Law. It covers families earning up to 400% of federal poverty level and makes manufacturers responsible for reimbursing pharmacies to cover the financial gap created by patients paying lower prices.

The work group also endorsed following the approach of Minnesota – contained in the same law – in allowing individuals, including those without insurance, to obtain a free, 30-day emergency insulin supply. As many as 465 people reportedly received insulin under this provision in Minnesota’s law during its first months.

Washington work group members expressed a strong desire to include insulin supplies like syringes and pen needles in such a program. Minnesota’s law does not have such a mandate.

If lawmakers want to pursue ideas mapped out in the report, additional analysis will be needed in areas such as costs and logistics, the report says.

Sen. Karen Keiser, D-Kent, sponsor of the law capping out-of-pocket monthly costs, said she’s interested in seeing if a program providing an emergency supply can be enacted in the 2024 session. It will be tough because the session will only last 60 days.

“When people run out of money and when they run out of insulin, they need to have an option,” she said. “It’s not a slam dunk but it’s not a totally new issue either. We have done work on it.”