Bill seeking to limit out-of-pocket spending on insulin passes Senate

In this Feb. 4, 2019 photo, a woman holds insulin provided to a diabetes patient. (Rodrigo Abd/AP)
In this Feb. 4, 2019 photo, a woman holds insulin provided to a diabetes patient. (Rodrigo Abd/AP)

A bill aimed at addressing the rising cost of prescription drugs, including limiting out-of-pocket spending on insulin for those trying to control their diabetes, was approved Thursday by the Massachusetts Senate on a 39-1 vote.

Twenty-one other states already cap co-payments for insurance.

The bill would eliminate deductibles and coinsurance and permanently cap co-pays at $25 for a 30-day supply of insulin.

Backers of the bill point to the rising cost of insulin, resulting in out-of-pocket costs that can reach $1,000 or more per year for patients in high-deductible plans or who are underinsured.

The legislation would also direct the state's Health Policy Commission to create a process to identify other drug price thresholds that pose a public health risk and recommend pricing measures to increase patient access to medications.

Drug manufacturers that fail to comply would be required to pay a fee into a trust fund for a new drug cost assistance program to support patients with chronic health conditions that disproportionately harm communities of color and low-income communities.

The bill would also give patients easier access to mail-order prescriptions and make sure they can get their prescription drugs from the pharmacy they choose by letting independent pharmacists become licensed to dispense specialty drugs.

Pharmacy benefit managers, who play a key role in how drugs are priced on insurance plans, would be subject to more oversite under the bill. Supporters say that without the oversight it’s unclear if the benefit managers are working in the best interest of consumers when they negotiate drug prices.

The legislation would help ensure patients buying prescription drugs aren’t charged a cost-sharing amount, such as a co-pay or deductible, that exceeds the drug’s retail price.

Pharmaceutical companies would also be required to alert the state in advance of new drugs coming to market, and of significant price increases for existing drugs.

The bill now heads to the Massachusetts House.



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