State Lawmakers Grapple With Rising Cost Of Insulin As Bill To Cap Copays Heads To House Floor

A bipartisan bill seeking to cap what some insured West Virginians pay for insulin is going to the full House of Delegates for consideration. This comes after eight amendments and several hours of discussion in the House Judiciary Committee on Friday.  

Delegates in committee agreed that the soaring cost of insulin is a real problem for West Virginians, but they questioned what authority the state has over manufacturers who establish the drug’s initial cost, and how limiting co-pays might negatively impact small insurance businesses and mom-and-pop pharmacies. 

House Bill 4543 would mandate that a 30-day supply of prescribed insulin cannot exceed $25, “regardless of the quantity or type of prescription.”  

The bill only applies to insured West Virginians under the state’s jurisdiction, through programs like the West Virginia Public Employees Insurance Agency (PEIA) or individuals who pay for their own private insurance. The bill doesn’t do anything for West Virginians covered by Medicare, Medicaid or private employment-based health benefits, which are all regulated by the federal government.   

“This is a step forward and I wholeheartedly support it,” Del. Barbara Evans Fleischauer, D-Monongalia, said before Friday’s vote. “I wish we had jurisdiction over all the other insurance plans, but we don’t. And I think we should take a step forward on what we are able to do as a state.” 

Fleischauer is one of the bill’s sponsors. The bill’s lead sponsor is the chair of the House Health and Human Resources Committee, Republican Jordan Hill from Nicholas County.  

Many of the changes made to the bill Friday were technical and dealing with unintended language. An amendment from Del. Andrew Robinson, D-Kanawha, could extend some of the benefits of the bill to uninsured and underinsured West Virginians, as well, by incentivizing pharmaceutical manufacturers — the companies producing insulin — to lower their prices, by eliminating the rebate process. 

Manufacturers get their drugs to insurance agencies with help from pharmaceutical benefit managers, which negotiate between the two sides to establish “rebates” requiring manufacturers to lower their prices to a certain point, as long as insurers include that type of drug on their health plan for their consumers. 

Rebates don’t benefit people without insurance who are trying to buy insulin. According to Robinson, pharmaceutical manufacturers will increase the out-of-pocket cost of their drug that these uninsured and underinsured consumers end up paying, to make up for the cost that comes with negotiating rebates.  

“Really, it doesn’t go into action unless we can actually reign in pharmaceutical manufacturers,” Robinson said after the vote. “If we can reign in those pharmaceutical manufacturers it would just help everyone.” 

If the bill passes both chambers and garners Gov. Jim Justice’s approval, West Virginia wouldn’t be the first to cap insulin copays. Colorado agreed in 2019 to set a $100 cap for insured consumers, and the governor of Illinois signed a similar bill in January. 

House Bill 4543 passed out of the House Banking and Insurance Committee earlier this week, where legislators questioned what message this bill will send to manufacturers, and whether this bill might dissuade them from making their insulin accessible to the West Virginians who need it.  

No one at the House Judiciary meeting on Friday spoke on behalf of manufacturers. 

Emily Allen is a Report for America corps member.