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Kentucky bill would cap insulin copays at $100 per month

Posted: 11:55 PM, Jan 17, 2020
Updated: 2020-01-18 11:02:38-05

INDEPENDENCE, Ky. — Ten-year-old Bryce George knows how lucky he is, he said Friday night. Although he’s had type 1 diabetes since he was a toddler, his family can afford to take care of him — both his parents have insurance, allowing them to purchase the insulin he needs to balance his blood sugar for only about $100 each month.

If they didn’t, they would be even more at the mercy of a pharmaceutical pricing system that’s raised the price of the life-saving drug by more than 300% in the last 20 years.

George’s mother, Elizabeth, estimates the monthly price without her insurance would be about $600.

“I always fear that if one of us loses our job or we lose our insurance, I don’t know where we’d come up with that,” she said.

A bill introduced Jan. 7 in the Kentucky state senate could help alleviate her fears and those of families across the state.

Senate Bill 69 would cap the copay for a 30-day insulin supply for insured Kentuckians at what the Georges pay now: $100.

The state insulin copay cap bills apply to insurance plans sold within Kentucky. They do not regulate copays on self-funded insurance plans governed under federal law by the Employee Retirement Income Security Act (ERISA).

Elizabeth George said it would be a relief to know her son would be safe even if her job or insurance plan changed. Other diabetics have been less lucky.

“They’re having to ration insulin,” she said. “They’re having to buy generic insulin at Walmart, which isn’t the same strength. I’ve even heard of some people who’ve gone into DKA, which is diabetic ketoacidosis, because they were rationing.”

Some have died attempting to make their limited insulin last as long as possible.

Bryce George said he works hard every day to ensure he’s taking the best possible care of himself. He pricks his finger eight times each day; he explains his condition to his classmates, who sometimes wonder why he can’t get a vaccine or whether his diabetes is contagious.

“I always call it a game of teeter-totter,” he said of his daily maintenance rituals. “If you go too low one side, you have to push yourself back up. If you go too high, you have to fall back down.”

He knows it’s not his fault he’s sick — it’s not the fault of anyone living with type 1 diabetes. He said he wishes everyone else with the condition could be as lucky as him.

“It makes me feel very sad, because I feel like I’m very well treated by my care and I feel very safe,” he said. “Some people, they can’t afford the good kind of insulin. They can only afford the store-bought brand, so I feel kind of bad for them. They can’t get the good type that helps them with their health.”