$35 co-pay

Sixteen states and counting have enacted laws capping the insurance co-pay for insulin. These laws only apply to state regulated insurance plans. They do not apply to federally regulated self-insured plans which includes about 60% of employers.

The President has proposed a national cap $35 and Medicare has a pilot program running.

You can debate why insulin above other life saving drugs is singled out, but once something becomes a political football anything can happen.

Hey, I’m still trying to figure out why birth control needs to be “free.”

Insulin is not on the list of top thirty used prescription drugs.

What many people may not realize is that laws like this add to the cost of their insurance, they increase premiums. Some studies have shown that state mandates add as much as 20% to the cost of insurance.

The bottom line is people paying premiums for insurance – employers, workers and other individuals will pay the cost between the co-pay and the actual cost of the medication. Costs are being shifted, that’s all.

2 comments

  1. The squeaky wheel gets the grease and insulin is the winner this go round. The top 30 chart is really informative since I thought insulin would have been on it due to all the news. I knew statins were #1 but not the rest.

    Cost shifting is the name of the game as you pointed out and the graying of the population means the costs will only go up from here.

    Liked by 1 person

  2. Instead of capping the copay, how about capping the charged price at some variant of the cost to create and produce? Employers don’t get off scot free here – they are the idiots that exempt Rx from the plan’s deductible and implement copayments instead of coinsurance – allowing the participants to ignore the actual cost of services and products. When the copay is $35, the participant thinks, that’s the cost to the plan. Then she/he complains about the cost of coverage increasing as well as their portion of the funding.

    Similarly, why allow other brand name Rx in the marketplace that offer no discernible improvement in health?
    See this 15+ year old study: https://www.webmd.com/heart-disease/news/20060313/aspirin-plavix-combo-no-clear-edge

    Would the states and the idiot Brandon administration take this step if the employee contribution was paid on an after-tax basis (like your social security and Medicare payroll taxes) and/or where the employer contribution for medical coverage had to be imputed as taxable wages to the employee (triggering FICA and FICA-Med for both the employee and the employer, plus employee-paid federal, state and local income taxes)?

    This is simply another vote buying effort. Yes, cost shifting allowing the pigs at the trough to suck up votes.

    Liked by 1 person

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