Written By: Paul Scott | Duluth News Tribune
Beginning in January of 2020, the 6,500 diabetic patients with Medica insurance plans in Minnesota will see their insulin costs capped at $25 for every 30-day supply of insulin, the Minnetonka-based insurer announced Monday, Aug. 5.
“This program is just one example of how Medica works to address the pressing health care issues our members are facing,” Medica President and CEO John Naylor said in a statement. “It is actions like this that our members and customers have come to expect as they put their trust in us and we support them with their health care needs.”
Qualifying Medica employer plans must serve companies based in the state of Minnesota, although employees can live out of state. The benefit is also available to all individual Medica plan holders who purchase ACA coverage in the state of Minnesota.
The $25 copay applies before the deductible, meaning even holders of high deductible plans will still see insulin costs capped at $25 a month, potentially saving some member hundreds of dollars in monthly out of pocket costs.
“We’re going to absorb the cost associated with that plan change,” said Larry Bussey, director of corporate communications for Medica. “We think it’s the right thing to do.”
New York-based insurance giant Cigna announced a similar plan in connection with Express Scripts pharmacy benefits company last April, although its Patient Assurance Plan announcement noted “eligible members” would receive the benefit, suggesting some restrictions. The state of Colorado capped the price of the drug at $100.
Diabetes rates are soaring in the U.S., with the majority of cases being adult-onset or Type 2 diabetes. This rise of diabetes caused a spike in demand for the synthetic hormone as a lifesaving stand-in for the body’s own insufficient supply, all atop the critical demand for insulin needed to avoid diabetic coma for patients with Type 1 or childhood diabetes.
Insulin is an old drug, first isolated in the 1920s, and its patent was sold by the discoverer to a public university for a dollar. The small, modern refinements on this early formula are both abundant and six times less expensive for patients in Mexico and Canada than in the U.S., making insulin something of a poster child for a dysfunctional American health care marketplace.
Minnesota lawmakers attempted to craft a bill to provide free insulin to those unable to pay, but the measure died in the waning hours of the 2019 session. With presidential candidates arguing for the legalization of importing drugs from countries offering cheaper prices, manufacturers may have begun to strike deals with pharmacy benefit managers, hoping to keep American insulin markets intact. But those transactions occur in secrecy, leaving insurers and patients in the dark.