State rep. from Hanover proposes bill to cap insulin costs for some patients

  • Garrett Muscatel

Valley News Staff Writer
Published: 11/10/2019 9:46:38 PM
Modified: 11/10/2019 9:46:36 PM

HANOVER — With millions of diabetics having to pay dramatically more out-of-pocket as the price of insulin rises, a first-term lawmaker is gathering support for legislation to curb such costs in New Hampshire.

State Rep. Garrett Muscatel, D-Hanover, plans to propose a bill this legislative session that would place a cap on some patients’ out of pocket costs for insulin.

Muscatel, a Dartmouth College senior, said his proposal would limit the price of insulin to $100 for a 30-day supply for people covered by state-regulated insurance plans. It’s based on a new law in Colorado, so he is optimistic it will pass.

“I don’t think it’s really a partisan issue,” Muscatel said in an interview. “People shouldn’t die because they can’t afford a drug that keeps them alive.”

More than 30 million people in the U.S., about 9% of the population, have some form of diabetes, according to the Centers for Disease Control and Prevention. In the Twin States, about 8% of adults in New Hampshire and 7% of Vermont adults have diabetes, according to the CDC.

The pancreas of a person with the less common Type I diabetes — often diagnosed in childhood — does not make the hormone insulin, which is necessary for the body to convert glucose from food to energy. In a person with the more common Type II diabetes, which can be diagnosed at any age, the body does not make or use insulin well.

The amount of insulin people with diabetes need to take varies, said Dr. Richard Comi, an endocrinologist at Dartmouth-Hitchcock Medical Center in Lebanon. And so does the cost they must bear.

In the past three or four years, Comi — who has worked at D-H for 30 years —​​​​ said the costs have increased dramatically in a way that seems unrelated to improvements in treatment options.

One study found that patient out-of-pocket expenses for insulin doubled over a 10-year period, according to a 2018 study by the Insulin Access and Affordability Working Group of the American Diabetes Association.

For patients covered by private insurance, the median out-of-pocket cost to patients went from $19 per vial of insulin in 2000 to $36 per vial of insulin in 2010, according to the study. And, average Medicare Part D beneficiary out-of-pocket costs for all insulin types doubled between 2006 and 2013, from $27 per month to $65 per month.

The group “especially harmed” by such increases are patients covered by Medicare, the government insurance for those over 65, Comi said.

These patients have a portion of their prescription drug costs covered, but then partway through the year hit a “doughnut hole” in their coverage where they are responsible for a larger portion of those costs. The averages identified by the American Diabetes Association working group did not factor in cost fluctuations due to this coverage gap or costs to patients when insulin prescribed by a provider is not covered by a patient’s insurance.

As a result of increasing out-of-pocket costs, Comi said some patients with diabetes end up in the hospital because they have tried to get by with less insulin than they need.

“It’s a huge problem,” he said.

Though inconvenient, other patients have found a way to reduce their costs by ordering insulin from Canada or, in some cases, traveling to Canada to get insulin, Comi said.

Comi said he likes that Muscatel’s proposal would even out the costs, so patients would have more predictability in their payments for insulin. He wasn’t sure, however, if $100 per month was the right price point because it could still be a burden for some.

And some specialists question whether the legislation would have much benefit.

Muscatel’s bill wouldn’t address the problem for the people who are most affected by high insulin costs — seniors and the uninsured — said Christopher Lopez, a clinical pharmacy specialist of population health and coordinator of diabetes education, management and prevention at New London Hospital and Newport Health Center.

“This isn’t going to have much impact at all,” said Lopez, who also is a member and past president of the New Hampshire Pharmacists Association.

Comi said he would like to see a policy change that would require insurance companies to cover prescription medications used to treat chronic diseases in a “uniform manner.” Because people need drugs such as insulin on a regular basis for the rest of their lives in order to survive, Comi said they ought to be in a different category.

He’d also like to see some price controls at a federal level that could, for example, allow Medicare to negotiate drug prices.

Federal lawmakers also are aware of the insulin pricing problem and have proposed legislation aimed at addressing it. For example, U.S. Sen. Jeanne Shaheen visited the Newport Health Center this summer to discuss the problem of the cost of insulin and promoted a proposed Insulin Price Reduction Act, which she’s put forward with a group of legislators including Sens. Susan Collins, R-Maine; Tom Carper, D-Del.; and Kevin Cramer, R-N.D.

Under Shaheen’s bill — which was referred to the Committee on Finance in July — pharmacy benefit managers and insurers would be barred from collecting rebates or other payment for insulin products purchased from manufacturers who reduce the 2020 list price of their product to the 2006 list price. To continue under the rebate restriction in the following year, manufacturers would be required to limit their list price increase to no more than medical inflation for the year.

Additionally, the bill would require that pharmacy benefit managers and private insurers waive the deductible for any insulin product that meets the list price reduction requirement.

Though Muscatel, who sits on the House Committee on Commerce and Consumer Affairs, acknowledged his bill’s limitations and the need for a federal solution, he said he aims to “start small and do what we can do at the state level.”

Muscatel grew up with friends who had Type 1 diabetes and “plenty of people I know here at Dartmouth have to purchase insulin to survive,” he said.

One way or another, Muscatel said the high cost of insulin, “affects all of us.”

The legislation also has the backing of several other lawmakers from the Upper Valley, including state Rep. Karen Ebel, D-New London and state Sens. Martha Hennessey, D-Hanover, and Ruth Ward, R-Stoddard.

Comi is scheduled to discuss diabetes treatment, research and prevention with D-H CEO Joanne Conroy in a Facebook Live session on Nov. 18 at noon on the D-H page. People can submit questions in advance by email at

Nora Doyle-Burr can be reached at or 603-727-3213.

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