Medica announced a new program Monday that will limit the monthly out-of-pocket bill for a 30-day prescription for insulin to $25 starting next year. The move means that the Minnesota-based insurer will absorb the excess costs above $25 for about 6,500 members. Premiums will not rise because of the move.
The spending cap doesn’t apply to Medicaid and Medicare members, but many Medicaid members already pay less than $25, as the Star Tribune of Minnesota reports.
The rising costs of insulin has sparked outrage in many quarters, including the FDA. Three companies—Eli Lilly, Novo Nordisk, and Sanofi Aventis—control 90% of the insulin market.
Medica CEO John Naylor tells the newspaper that “for some individuals, this could be savings of several hundred dollars a month from what they would have been paying. We are just stepping up to the plate and making an investment in our members.”
Insulins are biologics, but because they’ve been around for nearly 100 years, they are not regulated the same way that more recent biologics are regulated. The same goes for generic insulins. That will change in 2020, when insulin products will not be eligible for a 12-year exclusivity period now afforded biologics.
The Star Tribune reports that “Minnesotan Alec Smith became the subject of national news stories in 2018 after his family said the 26-year-old died when he couldn’t afford his $1,300 insulin refill cost after aging off his family’s insurance plan."