One of the problems created by Obamacare was the creation of health insurance plans that don’t cover much at all. For example, these high-deductible plans often have limited coverage for prescription drug benefits. Insurance coverage for prescriptions are listed on a “drug list” or “formulary” designed by insurance companies allowing those companies to decide how much coverage the insured will receive for the various treatments and prescription drugs prescribed by a physician.
There are complicated reasons why insurance companies have designed plans like this that burden many Minnesotans with enormous out-of-pocket costs. Yet politicians want quick and easy solutions to these complicated problems. The key to finding the best solution to these problems at the pharmacy counter is to not make matters worse. That’s easier said than done when legislators get involved.
Since Obamacare became law, many Minnesotans with chronic diseases like asthma, arthritis, and diabetes have discovered that their out-of-pocket costs for prescription drugs skyrocketed. This is often the case with high-deductible health insurance plans – the consumer has to pay the initial costs of a prescription drug until the deductible is satisfied.
This problem is exacerbated every January when health insurance co-payments for prescription drugs “reset” as well as for those seniors who use Medicare Part D prescription drug benefits. Health care deductibles have increased 360% since 2006 with patients paying more and pharmacy benefit managers making more.
Furthermore, if a prescription drug isn’t on your insurance plan’s formulary list, you essentially have no insurance for that drug and you’re on your own. And even once that prescription drug deductible is met, patients often will be forced to pay a large co-pay at the pharmacy counter every time they fill prescriptions for prescribed and medically-necessary medications.
There are complicated reasons why insurance companies have designed plans like this that burden many Minnesotans with enormous out-of-pocket costs but it really boils down to this: prescription drug rebates continue to be an enormous source of income for pharmacy benefit managers who essentially “control” drug coverage for health insurers. These prescription drug “middle men” prefer brand name drugs with higher prices because they receive huge rebates which is their financial incentive to keep drug prices high which make their profits rise even higher.
This complication creates an enormous financial strain for many Minnesotans who can’t live without necessary prescription drugs like insulin. Help is available today for Minnesotans who are insulin-dependent diabetics. Yet some Minnesota legislators are determined to make a serious and chronic disease like diabetes a political issue. Most of these legislative proposals will only make matters worse for Minnesotans who need help now.
The 2019 Minnesota budget bill included language to prevent insurers from “charging patients more than the net price for medications negotiated by the insurer.” As a result of this new law, many health insurance companies were forced to change the structure of their co-pays with some insured diabetics paying as little as $0 or $25 per month for necessary medications. These changes in insurance plans became effective just last month.
Also, in 2019 all of the insulin manufacturers announced plans for voluntarily lowering costs to consumers for this drug. For example, every uninsured American diabetic who uses Sanofi’s insulin products –regardless of income level – can purchase their insulin for a maximum out-of-pocket cost of $99 per month. Some diabetics with insurance would be eligible for plans that require a $0 co-payment per a 30-day supply of insulin. Drug manufacturer Eli Lilly has a similar program that Minnesotans can participate in regardless of their insurance status or income.
In addition, many low-income Minnesotans currently receive their monthly insulin through patient assistance programs provided by drug manufacturers. Currently every insulin manufacturer offers patient assistant programs that provide free or nearly free medicines to eligible patients. Many Minnesotans have used these programs for years. And if a patient’s income is too high to qualify for the free programs, most drug manufacturers will provide coupons for specific drugs that will greatly reduce the out-of-pocket cost at the pharmacy counter.
Emergency supplies of insulin are available today if a patient tells their pharmacist that they cannot afford their medicine or if they go to the nearest hospital emergency room.
It’s ironic that many of the same legislators who claim they are striving to help diabetics afford insulin today are also the same gang that proposes that Minnesotans not be allowed to use drug manufacturers coupons that allow consumers to save money on prescription drugs.
In spite of all this, market-based solutions are unfolding that respond to consumer demand for lower-cost insulin. It’s happening today – without the Minnesota legislature doing anything. The only thing that could make matters worse for Minnesotan diabetics is the unintended consequences that will unfold if ill-advised and hastily crafted political solutions to the high costs of insulin are allowed to become law.