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House bill would cap costs for diabetics

ALBUQUERQUE, N.M. — He was 5 when he arrived that winter in pilled pajama bottoms, T-shirt and shoes three sizes too big.

David, a social worker told us, had been hard to place because he has diabetes. None of the other foster families were willing to deal with needles and insulin and the stress over a potentially deadly disease.

He came with no instructions, only a small, stained paper bag filled with a vial of insulin, a few syringes and scraps of paper scrawled with numbers, the efforts of his intellectually disabled and homeless mother to keep records of his dosages.

As a foster – and then adopted – child, David was fortunate that Medicaid paid for his insulin and diabetic supplies.

Not everybody is as fortunate. But a bill backed by Gov. Michelle Lujan Grisham could make the cost of insulin and supplies more affordable to others.

House Bill 292 – introduced last week by sponsors Sen. Daniel Ivey-Soto, D-Albuquerque, and Rep. Micaela Lara Cadena, D-Mesilla – would cap monthly out-of-pocket insulin costs at $50.

That includes supplies like test strips, blood glucose meter, syringes and pens.

“Under this legislation, New Mexicans with diabetes will no longer have to choose between medication and other necessities,” Lujan Grisham said in a news release announcing the bill. “That is an unconscionable choice; no one should ever have to make it.”

Such caps have generated interest nationwide since Colorado implemented its $100 cap in 2019. Last week, the governor of Illinois signed a $100 cap into law, and state lawmakers are considering similar measures in Florida, Michigan, New Jersey, New York, Ohio, Pennsylvania and Wisconsin. In Utah, the proposed cap is $30 a month. In Massachusetts, it’s $25 a month.

The caps require the cost burden to be absorbed by insurance companies – which would be true in New Mexico, Cadena said.

Critics nationally have warned that insulin caps could raise insurance premiums, but so far that has not been the case in Colorado.

House Bill 292 has been assigned to the House Health and Human Services Committee, but a hearing has yet to be scheduled.

The average insulin price nearly tripled from 2002 through 2013, and prices have risen 10% or more a year since then, forcing many people with diabetes to shell out from $100 to nearly $500 for a single vial of insulin, depending on their insurance coverage, or ration their insulin and hope the consequences are survivable.

That’s on top of the cost for supplies. Test strips, for example, cost from $22 to $145 for a box of 50 at your neighborhood Walgreen’s.

According to the Centers for Disease Control and Prevention, one in seven adults with diabetes does not take medication as prescribed because of the expense.

“That is a huge out-of-pocket cost for the average American, and we wonder why diabetics are rationing their insulin and dying,” a friend, who has diabetes, wrote on social media recently after purchasing a vial of insulin for $99. “I need this to live.”

While the news of the bill is promising, it is still not a panacea for all people with diabetes. As in most states, the New Mexico cap won’t cover those without health insurance.

Cadena said it was unclear whether House Bill 292, if passed, would benefit those with plans subject to federal regulation for price caps, such as those under Medicare or Tricare, which covers military families.

And the proposed New Mexico cap does not hold pharmaceutical companies accountable for the dramatic rise in insulin costs.

House Bill 292 also includes language that would require the Office of the Superintendent of Insurance to study the affordability of other drugs, such as asthma medications and antidepressants. Cadena said she is hopeful that the study will lead to making technology improvements in diabetic care such as insulin pumps more affordable to New Mexicans.

“We are trying to bring some relief to families where it matters most,” she said.

New Mexicans who have diabetes should not need to be the rare fortunate ones like David to receive the medications they need to survive. House Bill 292 is a good start, but we still have much to learn on making life-sustaining medications affordable for all.

As for David, the day after he arrived we were hooked up with an endocrinologist, educator and dietitian for a crash course on insulin-dependent Type 1 diabetes.

He’s 22 and a pretty healthy guy, so we must have learned something.

UpFront is a front-page news and opinion column. Comment directly to Joline at 823-3603, jkrueger@abqjournal.com or follow her on Twitter @jolinegkg. Go to www.abqjournal.com/letters/new to submit a letter to the editor.

 

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