Politicians at the state and federal level have pushed for a limit to the price of insulin, which can cost hundreds of dollars a month, depending on circumstances. For the thousands of people in the Yakima area living with diabetes, insulin price caps could help them better navigate medical costs.
Most people’s bodies naturally regulate insulin, which helps process the blood sugar people get from food. But people with Type 1 diabetes cannot live without medicinal insulin since their bodies do not produce it naturally. Some people with Type 2 diabetes also need to take insulin shots, according to the American Diabetes Association.
Americans pay far more for medicinal insulin than people in other developed countries, according to the RAND corporation. But recent political pressure could bring that cost down for some Americans.
Political pressure
Multiple politicians have recently pushed for a cap on the price of insulin, but limits would not apply to everyone equally.
Gov. Jay Inslee signed a bill earlier this month that will cap that price at $35 a month, according to the Associated Press. That limit will remain in place for all of 2023. The current out-of-pocket maximum price for a 30-day supply of insulin in Washington is $100.
The limit only applies to people on state-funded health plans, such as people on certain types of Medicaid or who work for the state, according to the Seattle Times. It does not apply to private insurance.
A bill that would create a work group to find a way to bring down insulin costs passed the Washington Legislature and awaits approval from the governor. That group must submit a final report on solutions to the Legislature by July 2023.
In his 2022 State of the Union Address, President Joseph Biden called for a national $35 limit on the price of a 30-day supply of insulin. The limit proposed in Biden’s infrastructure package, currently stalled in the Senate, would only apply to people with health insurance.
In February, Sen. Raphael Warnock, D-Georgia, introduced the Affordable Insulin Now Act to the Senate. It would limit co-payments on insulin to $35 for a 30-day supply starting in 2023. This limit would also only affect people with private insurance or certain Medicare plans, according to a news release from Warnock’s office.
About 15% of people in Yakima County are uninsured, according to a 2021 estimate by the U.S. Census Bureau.
Diabetes in Yakima
Yakima has a higher rate of adults diagnosed with diabetes than the state does. In 2019, 12.6% of adults in Yakima County had a diabetes diagnosis, compared to 8.7% of adults in Washington, according to Yakima Valley Trends, which has data compiled by the Eastern Washington University Institute for Public Policy and Economic Analysis.
Yakima Neighborhood Health Services CEO Rhonda Hauff said that its centers see about 2,000 patients with diabetes.
In Washington, one in three adults has prediabetes, according to the state Department of Health. People with prediabetes have a higher risk of developing Type 2 diabetes.
Low income people are also disproportionately likely to develop Type 2 diabetes due to systemic inequalities, according to the American Diabetes Association. Latinos, Indigenous Americans, Black Americans and some Pacific Islanders and Asian Americans are at higher risk to develop Type 2 diabetes, according to the Centers for Disease Control and Prevention.
The current price of a 30-day supply of insulin can vary widely based on circumstances, from nothing to hundreds of dollars, according to health care providers. And one vial of insulin can last longer for some people, depending on how much they require.
Hauff said most YNHS patients are low income. Various programs are available to help low income people afford insulin.
As a neighborhood health center, YNHS can purchase insulin at the federal drug price, which is significantly less than the retail price. Hauff estimated most patients who qualify for assistance pay around $10 a month for insulin.
YNHS Pharmacy Director Sarah Stephenson said that its clinics have a sliding scale for patients without insurance. Health center staff can discuss options to pay for insulin with uninsured patients.
“It’s definitely more affordable,” she said of the sliding scale.
Stephenson said community members do not always know about the neighborhood health centers and how they can save people money on medical costs. When she used to work in retail pharmacy, she would sometimes refer people to YNHS for more affordable care.
A ‘life-changing’ price limit
A permanent state or federal limit on the price of insulin could affect thousands of people in the Yakima Valley.
“For some patients, major, life-changing,” Stephenson said of the potential impact.
She said in her previous work in retail pharmacies, she saw people have to choose between affording groceries and affording insulin.
For people who make too much to qualify for assistance, insulin can quickly become a financial burden. Stephenson also said some people who have Medicare end up with gaps in coverage, that can make their monthly insulin prices vary widely.
“There’s always that group that gets stuck in the middle,” she said.
Hauff said that even though a state or federal insulin price limit might not directly affect the cost of insulin for YNHS, it would impact people in the community who do not currently qualify for assistance.
Jennifer Hilmes, a registered nurse and certified diabetes care and education specialist at Yakima Valley Memorial Hospital, said she has had patients ration insulin or borrow it from fellow diabetics. Going without the needed amount of insulin can lead to kidney problems, vision issues, increased risk of infection, and damage to the feet or nervous system.
A cap on the price of insulin could help put an end to insulin rationing, she said.
“I think it would give people a better idea what to expect each month, each time they go to visit the pharmacy,” she said.
She advised people having trouble with insulin costs to speak with a health care provider and discuss their options.
