Capping Insulin Co-pays Could Help Fight COVID-19

By Frank Lavernia, MD

I have been a doctor for 35 years and I have seen a lot of crises.  But I have never seen the country’s health care resources strained the way they are right now.  Supplies, equipment and hospital beds are needed to treat patients who are suffering from severe complications of COVID-19.  Now more than ever, policy should support keeping those living with chronic conditions, such as diabetes, stable so they don’t require urgent care.

Capping monthly co-pays for insulin is one such policy solution.

Colorado was the first state to put the idea into action.  Gov. Jared Polis signed a bill capping co-pays last May; it took effect in January.  And within weeks lawmakers committed to amending it, clarifying that the $100 cap applies to a patient’s total insulin costs in a given month, not each individual insulin prescription.  Some patients use two or even three different kinds of insulins to manage their diabetes.

Illinois was next, likewise instituting a $100 cap for a 30-day supply, even for patients who use two or three types.  And just this month, New Mexico set a cap of $25 for a 30-day supply. 

More than 30 million Americans have diabetes, so limiting co-pays for insulin could have a broad, lasting impact.  The average price of insulin jumped approximately 15% each year between 2012 and 2016, according to the American Diabetes Association.  Price increases have continued since then. So have heartbreaking stories about people rationing their insulin, skipping doses or buying insulin on the black market because they cannot afford it from their pharmacy.  

More than 10 other state legislatures started looking at co-pay caps for insulin this spring.  

Even the federal government is taking note.  Earlier this month, the Centers for Medicare and Medicaid Services said it will test a new Medicare plan design that caps out-of-pocket insulin costs at $35 for a 30-day supply.  CMS noted that predicable, affordable co-pays can increase patients’ adherence. Meanwhile, the Veterans Health Administration has made insulin more affordable for patients it covers.  It charges as little as $15 for a 90-day supply in some parts of the country. 

These are hopeful signs that policymakers are starting to pay attention to this critical access issue.  What’s more, these policies can keep people with diabetes stable at a time when our country’s health care system is in crisis.  Living with diabetes puts people at an increased risk of COVID-19; those with poorly controlled diabetes are at an even greater risk.  By protecting access to insulin, policymakers help keep people living with diabetes healthy, reducing the coronavirus’ impact on public health.  Equally important, they free up our hospitals and clinics to serve vulnerable and infected patients who need immediate care. 

Frank Lavernia, MD, is a diabetes specialist and a member of the Alliance for Patient Access’ Diabetes Therapy Access Working Group.


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