AUGUSTA — Kate Brogan’s 6-year-old son, Nathan, needs insulin to live. He’s one of thousands of Mainers with type 1 diabetes, and even though “he’s 6 and his body is small,” as his mother told lawmakers on Tuesday, his insulin costs $300 a month.
Brogan spoke in support of a bill before the Committee on Health Coverage, Insurance and Financial Services that would cap the insurance co-pay costs for a 30-day supply of insulin at $100 in Maine. She was among dozens who stepped up to tell their stories.
Brogan said the escalating cost of insulin has put a heavy burden on families like hers, and while she currently has a good health insurance plan, she has a $1,500 monthly premium and still pays $300 a month out of pocket for her son’s insulin. That doesn’t include a host of other supplies from blood-sugar test strips to syringes, that are often not covered by insurance providers, Brogan said.
The legislation sponsored by House Speaker Sara Gideon, D-Freeport, is one of four bills before the committee as part of the Patients First Health Care Package, which aims to slow the accelerating costs of health care and prescription drugs. Another bill in the package seeks to protect patients from unexpected costs when they find themselves voluntarily or involuntarily being treated by providers outside of their insurance plan networks.
Another bill creates pricing transparency for the 25 highest-cost medical procedures. It requires health care providers to tell patients the average statewide cost for a procedure and to disclose to the patient the providers that offer the service at the highest and lowest rates.
Gideon, who is running in the Democratic primary for a chance to challenge Republican incumbent U.S. Sen. Susan Collins in the November general election, said the insulin bill isn’t a panacea. But she said Maine should act because the federal government has failed to cap the price pharmaceutical companies can charge for a life-sustaining medication that’s been available for nearly 100 years.
“While there have been many advancements in the creation and delivery of insulin since then … the fact remains that this drug is literally a lifesaver,” Gideon said. “But recently, it’s becoming something else – a source of steady profit for the pharmaceutical companies that produce it.”
Citing a report from the Health Care Cost Institute, a nonprofit, nonpartisan organization that studies health care data, Gideon said the cost of insulin had doubled from 2012 to 2016, rising from $2,864 to $5,705 per person, per year.
She noted that states lack the authority to set drug prices, but they can regulate insurance companies.
Diabetes is one of the most common chronic illnesses. Thirty million Americans and 142,000 Mainers have diabetes, about 10 percent of the state’s population.
Bills to cap insulin costs also are under consideration in other states, including Massachusetts, New Hampshire, Illinois and Wisconsin. Colorado has passed a bill to cap insulin costs.
About 30 percent of American diabetes patients ration their insulin because of high costs, according to a study released in January 2018 in JAMA Internal Medicine, a scholarly journal. In one high-profile case, a 21-year-old Minnesota man died from rationing his insulin last summer, several media outlets reported.
Brogan and other parents also urged lawmakers to consider going even further and considering bills like ones pending in Minnesota that would require a free 40-day supply of insulin for a person who has run out and who may not have the $100 co-pay need to refill a prescription.
The committee also heard testimony on a bill sponsored by Senate President Troy Jackson, D-Allagash, that would set up a state commission to study health care costs and delivery, and make recommendations for changes to the Legislature.
Although most of the bills were greeted with widespread support – Gideon said she had 119 Democratic and Republican co-sponsors on her bill – there was pushback on some of the proposed legislation Tuesday.
Dan Morin of the Maine Medical Association, which represents 4,300 physicians, testified in opposition to Jackson’s bill, saying it mainly focused on cost containment, while ignoring patient outcomes. Morin added that doctors already are overburdened with both insurance company and government bureaucracy, and often spend more time dealing with paperwork than practicing medicine.
“One physician … told me that her mission was to care for patients, not spend time explaining to a third party the need for a particular drug or test, responding to a billing inquiry or explaining to an insurance carrier why a colonoscopy was necessary,” Morin said.
He said doctors already have too many people looking over their shoulders.
“Because physicians feel like they have 58 people in the exam room every time they see a patient,” Morin said.
The committee will discuss the bills during work sessions Thursday.
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