Put a price cap on insulin in Florida

The Issue

I am a Type 1 diabetic and I have been since 1994. Just a couple of years ago the cost for a 3-month supply of Novolog insulin, which I have to inject every time I eat, was $100. Now, a 1-month supply costs $458.77 and there is no discount for a 3-month supply, meaning I would have to pay almost $1,500 for a 3-month supply -- about $6,000 a year for just one type of insulin.

However, pricing elsewhere shows that this high cost is not necessary. Canada’s price for insulin is $90, and Colorado recently passed an insulin price cap of $100 per month. It's time for Florida to join Colorado in passing a price cap on this life-saving drug.

Type 1 diabetes, which according to the CDC accounts for about 5 percent of all diagnosed cases of diabetes, is an autoimmune condition in which the body attacks and destroys the insulin-producing beta cells of the pancreas. Because their bodies cannot make insulin, type 1 diabetics require insulin prescriptions to live (in some extreme cases this is true for type 2 patients as well). 

"When type 1 diabetics take less insulin than they need, at the expense of having higher blood sugars… glucose rises significantly and in an attempt to find alternate fuels for the brain, keto acids are formed which are potentially toxic and lower the body's pH. DKA (Diabetic Ketoacidosis), when left untreated, can be lethal, and can set in quickly. In the absence of insulin a person might get DKA within 24 hours," - Robert A. Gabbay, the Chief Medical Officer and Senior Vice President at Joslin Diabetes Center in Boston.

The price of insulin has skyrocketed in recent years, with the three manufacturers — Sanofi, Novo Nordisk and Eli Lilly — raising the list prices of their products in near lock step, prompting outcry from patient groups and doctors who have pointed out that the rising prices appear to have little to do with increased production costs.

In the United States, just three pharmaceutical giants hold patents that allow them to manufacture insulin: Eli Lilly, Sanofi and Novo Nordisk. Put together, the “big three” made more than $12 billion in profits in 2014, with insulin accounting for a large portion.

Because of the incredibly high cost of insulin and other expensive supplies to handle their diabetes, many diabetics are forced into dire situations. Many diabetics have resorted to rationing insulin, risking their lives every day because they can’t afford to pay for their next vial. People are forced to choose between the insulin they need to survive, and keeping a roof over their head and food on the table for their families. People’s lives shouldn’t be put at risk because the insulin they require to live isn’t deemed “necessary” by insurance.

The insulin price cap in Colorado has shown that it’s possible for states to take control of outrageous insulin pricing and as a result, to save lives. It’s time for Florida to join them in protecting Floridians with diabetes from avoidable health risks. I urge you to look into the legislation that Colorado passed as a potential example for Florida to follow.

103,217

The Issue

I am a Type 1 diabetic and I have been since 1994. Just a couple of years ago the cost for a 3-month supply of Novolog insulin, which I have to inject every time I eat, was $100. Now, a 1-month supply costs $458.77 and there is no discount for a 3-month supply, meaning I would have to pay almost $1,500 for a 3-month supply -- about $6,000 a year for just one type of insulin.

However, pricing elsewhere shows that this high cost is not necessary. Canada’s price for insulin is $90, and Colorado recently passed an insulin price cap of $100 per month. It's time for Florida to join Colorado in passing a price cap on this life-saving drug.

Type 1 diabetes, which according to the CDC accounts for about 5 percent of all diagnosed cases of diabetes, is an autoimmune condition in which the body attacks and destroys the insulin-producing beta cells of the pancreas. Because their bodies cannot make insulin, type 1 diabetics require insulin prescriptions to live (in some extreme cases this is true for type 2 patients as well). 

"When type 1 diabetics take less insulin than they need, at the expense of having higher blood sugars… glucose rises significantly and in an attempt to find alternate fuels for the brain, keto acids are formed which are potentially toxic and lower the body's pH. DKA (Diabetic Ketoacidosis), when left untreated, can be lethal, and can set in quickly. In the absence of insulin a person might get DKA within 24 hours," - Robert A. Gabbay, the Chief Medical Officer and Senior Vice President at Joslin Diabetes Center in Boston.

The price of insulin has skyrocketed in recent years, with the three manufacturers — Sanofi, Novo Nordisk and Eli Lilly — raising the list prices of their products in near lock step, prompting outcry from patient groups and doctors who have pointed out that the rising prices appear to have little to do with increased production costs.

In the United States, just three pharmaceutical giants hold patents that allow them to manufacture insulin: Eli Lilly, Sanofi and Novo Nordisk. Put together, the “big three” made more than $12 billion in profits in 2014, with insulin accounting for a large portion.

Because of the incredibly high cost of insulin and other expensive supplies to handle their diabetes, many diabetics are forced into dire situations. Many diabetics have resorted to rationing insulin, risking their lives every day because they can’t afford to pay for their next vial. People are forced to choose between the insulin they need to survive, and keeping a roof over their head and food on the table for their families. People’s lives shouldn’t be put at risk because the insulin they require to live isn’t deemed “necessary” by insurance.

The insulin price cap in Colorado has shown that it’s possible for states to take control of outrageous insulin pricing and as a result, to save lives. It’s time for Florida to join them in protecting Floridians with diabetes from avoidable health risks. I urge you to look into the legislation that Colorado passed as a potential example for Florida to follow.

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103,217


The Decision Makers

Nicholas X. Duran
Former State House of Representatives - Florida-112
Responded
Last month I proudly filed HB 109 Prescription Insulin Drugs. This legislation would require individual and group health-insurance policies and health maintenance organizations to cap customers’ monthly cost-sharing obligations for insulin prescriptions at $100 for a 30-day supply of insulin. As the Democrats’ most senior member of the Florida House’s comprehensive health care committee, as well as the Health Care Appropriations Subcommittee, I have decided to take on the challenge of addressing skyrocketing prescription insulin drug prices. In Florida, it is estimated that over 2.4 million people have diabetes and over 5.8 million have pre-diabetes. Being able to afford prescription insulin is crucial for these individuals to properly treat their medical condition. In 1996, the price for a 1-month supply of insulin was $21. As of 2001, that exact vial’s price increased by $14 to $35. Now, according to Truven Health Analytics, that vial is said to be around $275. That is a 1200% increase on the original price. This astounding rise in the costs of necessary medication has led many patients to forego their prescription insulin because they simply cannot afford it. A peer-reviewed study found that one in four individuals living with diabetes began trying to ‘stretch out’ their doses of insulin by taking less than they were prescribed or even failing to fill prescriptions due to their inordinate costs. In the United States, these cost increases have put patients at risk and even have led to loss of life. In the 2019 Session, the Florida Legislature passed a new law that would allow the state to establish Canadian and international drug-importation programs that require federal approval. However, because current federal law excludes biologic drugs like insulin, it appears Florida’s new program may not even benefit patients who need insulin. Another issue is the length of time it will take for U.S. Health & Human Services to finalize the rules on the importation program. This is a lengthy (can be several years) process. Many people do not have time so we are taking direct action now.
Janet Cruz
Florida State Senator - District 18
Responded
Let me start by thanking all of you. This process works much better—the way it should—when the people are engaged. Signing this petition and becoming more aware of this issue that affects so many people in our great state is just the first step. This is a process, and unfortunately, it takes time and quite a bit of collective effort. I filed my bill, SB 116 Prescription Insulin Drugs, after seeing the great work Representative Dylan Roberts accomplished in Colorado. I know the same is possible in Florida, and will need the support of all of you to ensure this bill can achieve that same result. In The Florida Senate, bills are referred to committees. In order for a vote to take place on the Senate Chamber Floor, and be presented to the Governor (at which point he can sign or veto if it has passed through both the Senate and House) each bill must be voted favorably through all of its referred committees. SB 116’s first committee of reference is Banking and Insurance, led by Chair Doug Broxson. It is my hope all of you to continue to take an active role in this endeavor. I know lives are at stake, my own mother has quietly struggled with affording her insulin as a diabetic, and I know firsthand how burdensome it was for her. This isn’t about whether or not the large pharmaceutical companies, the pharmacy benefit managers, or the insurance companies are to blame—it doesn’t matter. We need to remove the patients from the equation. These entities have the capital and power to fight amongst one another over rebates and contracts, and that should be the fight, not diabetics fighting to survive.
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Petition created on June 30, 2019