From the Seattle Times
Before the coronavirus pandemic closed most travel between Canada and the United States, a border guard would ask Molly Stenson why she was making a trip to British Columbia just to buy insulin.
Stenson, a Mason County resident with Type 1 diabetes, says officers were usually understanding once she explained that in Canada, Costco sells her lifesaving medication for a fraction of what she would pay in the U.S. — saving her hundreds of dollars a month.
“As long as you aren’t bringing back huge amounts, you’re fine,” said Stenson, 30, adding that skyrocketing prices in the U.S. have led her to ration her medicine. “But I don’t want to push my luck coming back with like 15 vials for a three-month supply.”
From 2012 to 2016, the average price of insulin in the U.S. nearly doubled to about $450 per month, and studies show as many as 25% of diabetics ration their medication — a practice that can lead to kidney failure, blindness and death. But in Canada, Stenson could get her monthly amount for around $100.
Soon, she’ll be able to do the same in Washington. The state Legislature approved a bill this past session to limit out-of-pocket costs at $100 for a month’s supply. Washington is one of few states that have implemented a copay cap. Last year, Colorado was the first state to do so.
But Washington’s cap, which would apply to plans renewed in 2021, is temporary. Many hope state lawmakers can come up with more long-term solutions before the price cap expires in 2023.
The cap is a relief to Stenson, who as a manager of a retail store has health insurance but says the five-hour drive to Canada was still worth the trip.
Despite pushback from insurance companies, including Kaiser Permanente, Regence BlueShield and Premera Blue Cross, the $100 price cap received bipartisan support in the Legislature. Lawmakers heard compelling testimony, including that of an 8-year-old boy whose mother was struggling to afford his insulin.
In Washington, about 686,000 people have diabetes, and an estimated 226,300 rely on insulin. In 2017, diabetes was the seventh leading cause of death in the state, according to the Department of Health (DOH).
“Changes are good that we all know someone with diabetes,” said Colleen Thompson, legislative affairs director for the DOH. “And this disease is forever.”
Thompson also noted that those with diabetes, on average, are hit with higher health-care costs, which can “compete with other costs, such as feeding your family or paying household bills.”
“It could be that the insurance companies might have a little more money to pick up because of that cost cap,” said Sen. Karen Keiser, D-Des Moines, who sponsored the bill. “I really don’t care at this point.”
Keiser said she’s happy with what got passed, as it creates the “infrastructure” to find more permanent solutions in the next two years. It also calls for creation of an insulin work group, tasked with reviewing and designing strategies to reduce the cost of and total expenditures on insulin in the state
Mel Sorenson, representing America’s Health Insurance Plans, testified against setting price limits for drug purchasers, arguing that price-fixing strategies “despite good intentions, rarely actually work.”
In testifying against a $100 copay cap, a representative for Kaiser Permanente argued that insurance companies, who will have to foot the rest of the bill, may be forced to raise premiums.
A drug distributor or wholesaler will also be on the work group, as will representatives from health-plan carriers and an individual with diabetes.
Keiser said she expects the group members to work in their own interests, but that the state needs their expertise to understand how the health-care system works.
Kevin Wren, a Type 1 diabetic and insulin advocate, will represent people with diabetes and is happy to do so but noted he’ll be the only patient on the panel, in contrast to several seats reserved for those in the health-care industry.
He also argued that while a $100 cap would have prevented him from rationing insulin earlier in life, that price still isn’t low enough.
One study estimated that a year’s supply of insulin could be profitably manufactured and sold for less than $133.
“Manufacturers are still making hookah bucks off of the $100 cap,” Wren said.
As for Stenson, she says she has lots of friends who are Type 1 like her. She says having to shell out hundreds of dollars just to stay alive each month gives them a bond. But a lot of those friends are in states without a price cap, and aren’t able to make the trip to Canada.
And now that border crossings to Canada have been restricted due to coronavirus fears, Stenson is scrambling to figure out how and where to get her prescription, including asking friends in other countries to ship it to her.
“It does frustrate me,” Stenson said. “Something bigger needs to be done.”
By Claudia Yaw