Delaware Public Media

New legislation would cap insulin costs for Delawareans with private insurance

Jan 11, 2020

Delaware lawmakers are introducing a bill that would save money for part of Delaware’s diabetic population. The new law would cap the cost of insulin at $100 a month for Delaware patients with individual, group or state employee insurance plans.

The average per patient cost of insulin nationwide was about $450 a month in 2016, according to the Health Care Cost Institute.

David Bentz (D-Bear) is one of three Democratic state reps sponsoring Delaware’s bill. He says a statewide cap would protect diabetic Delawareans with high copays.

“Individuals who maybe don’t have a prescription drug plan, or perhaps they are on high deductible, high [sic] copay plan that are more catastrophic,” said Bentz. “Those are people who, kind of, fall into that lower-income, but working class individuals who don’t have as robust employment plan.”    

The bill would require insurance companies to pick up the remaining cost of insulin exceeding $100 per month for qualifying patients. It would also require the companies to include at least one insulin medication on the company’s lowest tier plan—which typically cost less.

“This isn’t something that’s going to apply to everybody,” said Bentz. “It’s a select group of people who are going to see their out of pocket costs go down and I don’t think it’s going to be a massive expense at all for insurance companies, and I certainly think they can afford to take this on, to the benefit of a lot of people who are going to need it.”   

If it is passed, the new law would take effect in 2021. Illinois and Colorado have passed similar legislation.

Medicaid patients in Delaware currently have a $15 cap on out-of-pocket monthly insulin expenses.

Nearly one-fourth of all Delaware adults are either diabetic or are at risk of developing the disease, according to a recent state health report.