NY agreement locks in $35 insulin price for uninsured over next 5 years
The price of insulin will be locked at $35 per month over the next five years for uninsured New Yorkers under an agreement announced Tuesday. Credit: Syntax / Reed Saxon
Uninsured New Yorkers who need insulin to manage their diabetes will pay no more than $35 a month for the prescription according to an agreement announced Tuesday between the state attorney general’s office and two major drug companies that locks in the price for at least five years.
Attorney General Letitia James had previously launched an investigation into the price of insulin, which her office said nearly tripled between 2002 and 2013. While a person with Type 1 diabetes paid about $2,864 a year on insulin in 2012, that amount jumped to $5,705 in 2016, according to the AG’s office.
As a result, some people were forced to ration or stop taking their medicine because of the high cost. Experts said diabetics face serious health risks if they don’t have insulin to help control their blood sugar.
Dr. Tarika James, chief medical officer at Harmony Healthcare Long Island, which treats uninsured and underinsured patients at sites throughout Nassau County, said the price cap will help people struggling to pay for their insulin.
“For patients who don’t have insurance, despite the fact that we have a discount pharmacy program, it can still cost over $1,000 a month for one prescription,” she said. “That is not affordable for many of our patients.”
While both Eli Lilly and Company and Sanofi-Aventis U.S. LLC had previously announced they would cut the out-of-pocket cost of insulin to $35 a month, the agreement locks that price in for uninsured New Yorkers for five years.
Both companies agreed to set up a process so that pharmacies will alert cash-paying customers about the $35 cap. They also pledged to continue and expand programs that provide free insulin to people most in need around the state.
More than 37 million people in the United States have diabetes and 1 in 5 don’t know they have it, according to the Centers for Disease Control and Prevention. Diabetes is the eighth leading cause of death in the United States and that number may be underreported, the agency said.
James in a statement said uninsured New Yorkers "can breathe a sigh of relief."
“Lifesaving medication should be affordable and accessible for all New Yorkers regardless of their income or insurance status,” she said.
When those patients stop taking insulin because they need the money for food, rent or other necessities, they are taking a chance with their health, Dr. Tarika James said.
“With uncontrolled glucose levels, you put yourself at risk of diabetic shock,” she said. “Some long-term consequences could be nerve damage, vision loss, worsening circulation and heart conditions. The sugar causes damage to many organs throughout the body.”
An analysis by the health policy nonprofit KFF found that among non-elderly adults taking insulin, 30% of those without health insurance reported rationing insulin due to cost in 2021, said Krutika Amin, associate director for the program on the Affordable Care Act at KFF, previously known as Kaiser Family Foundation.
She pointed out the Inflation Reduction Act passed by Congress last year capped insulin copays at $35 a month for people covered by Medicare.
“People without insurance particularly face affordability issues at pharmacy counters and doctor’s offices,” Amin said. “Insulin is one of those drugs people need for survival.”
She said it’s important to make sure people are aware of the cap when they go to pick up their medicine and make free insulin programs easily accessible for those not able to afford the copay.
“For low-income people, even $35 can be prohibitive,” Amin said.
Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.