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Jeffrey D. Allred, KSL, File

Break on insulin costs coming sooner than expected for Utahns as program starts June 1

By Sahalie Donaldson, KSL | Posted - May 25, 2020 at 6:37 p.m.



SALT LAKE CITY — A savings program for Utahns with diabetes will be seven months earlier than anticipated, giving state residents the chance to take advantage of the Public Employees Health Plan’s discounted insulin rates.

“This is part of a broader campaign to prevent people from dying unnecessarily because they don’t have insulin,” said Rep. Norm Thurston, R-Provo, sponsor of HB207 that passed the Legislature March 10 and created Utah’s Insulin Savings Program. “That should never happen. There should be nobody in the state that dies because they don’t take enough insulin. We want to put an end to that.”

The savings program will launch June 1. It was originally supposed to go into effect Jan. 1, 2021.

Insulin prices have skyrocketed in recent years, prompting anxiety for many individuals with insulin-dependent Type 1 diabetes. A vial of insulin, which cost approximately $20 in 2002, has jumped to nearly $350 today.

To combat these increased costs, some people with diabetes were forced to ration their medication, according to testimony heard during the 2020 legislative session. Rationing insulin is dangerous and can lead to significant health complications like blindness, kidney failure or death.

Thurston, who has tackled drug transparency issues for years, said the discount provided by the Public Employees Health Plan is about 60%. Currently, a vial costs about $350 at full price, but the reduced cost would come to about $100, he said.

The program “will make insulin more affordable for those without insurance, those having to pay out of pocket and for those with high deductibles,” said Mindie Hooley, chapter leader of T1 International Utah.

“With the discount of the PEHP program, no one in Utah will have to pay full price for insulin anymore and that alone is lifesaving,” she said.

Hooley and her group worked with Thurston to create HB207, meeting with the Utah County lawmaker to discuss ways to make accessing insulin in Utah affordable.

She said the COVID-19 pandemic has caused many chapter members to reach out to her after losing jobs and their employer sponsored health insurance “scared to death” because they don’t know how they’ll be able to purchase their insulin.

Thurston explained the program is opening sooner than anticipated because working the details out proved to be “a lot simpler” than expected and the Public Employees Health Plan was able to accelerate the program’s implementation.

“We are excited about the fact that things can go quickly and that our partners are willing to go quickly,” he said. “We are seeing people want to engage and help people out.”

Utahns will be able to register for free with the plan to participate in the program. They’ll be given a card to a pharmacy to qualify them for the discount price negotiated for members — essentially, it allows “anybody in the state of Utah to take advantage of PEHP’s discounted contract,” Thurston said.

According to Thurston, the effects will be widespread as some individuals need as many as four or five vials of insulin a month, paying upward of $1,500. The program would drop the cost to around $400 or $500 a month, which will vastly help families with their budgets, he said.

“They are going to be more likely to get the insulin they need and more likely to take the insulin they need because they’re not worried so much about the financial impact,” Thurston said.

An additional aspect of HB207 that went into effect May 12 allows pharmacists to refill expired prescriptions on an emergency basis, such as an expired prescription or instances where an insurance plan no longer covers an individual’s insulin.

Thurston said he doesn’t want anybody to ever leave a pharmacy without the insulin they need. The change in law allows pharmacists to help individuals leave “with enough insulin to help get them through.”

HB207 will also cap copays for insulin at $30 per month, though insurers can waive deductibles and put the treatment in their lowest-cost drug tier instead if they choose. This aspect of the bills goes into effect in January.

Thurston said he’s been working with insurance companies to figure out solutions to make insulin more affordable. Insurance companies must provide their own low cost or no cost insulin program plan or will be held to the $30 copay requirement, he explained.

“I like the fact that not every insurance plan is the same,” Thurston said. “People can shop, it’s competitive, you can see what works best for you and people will try different solutions and come up with something good, but they all will be low cost or no cost.”

Some health insurance plans in Utah are regulated at the federal level and the law does not apply to them, Thurston explained. In these circumstances, the PEHP program “provides a backstop” for those who aren’t insured or those with an insurance plan that isn’t regulated and refused to do a “low cost, no cost” option.

Hooley said the law “will help a good majority of the insulin dependent diabetic community.” She said her chapter will be back during the 2021 legislative session “fighting harder for the uninsured” and bringing awareness to the cost of diabetic supplies, but still it’s a step in the right direction.

“This bill is literally lifesaving and I will be jumping for joy the moment I hear someone doesn’t have to walk away from the pharmacy counter like my son had to do because he couldn’t afford $800 for his insulin. Insulin isn’t a choice for Type 1 diabetics. They have to take insulin or they die,” Hooley said.

Sahalie Donaldson

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