Legislator Q&A: Colorado Enacts Nation’s First Insulin Cost Cap, Requires Attorney General to Investigate Prices
In 2019, Colorado became the first state to pass legislation to cap insulin costs. The law, introduced by state Rep. Dylan Roberts, prohibits health insurers from charging enrollees more than $100 for a 30-day supply of insulin. It also requires the state’s attorney general to investigate insulin pricing and report the findings to the state legislature by Dec. 1, 2020.
The National Academy for State Health Policy (NASHP) spoke with Roberts to learn about the legislation, what he hopes it will accomplish, and what advice he would give lawmakers in other states who are considering a similar approach.
Since 2018, attorneys general in Minnesota and Kentucky have filed lawsuits against pharmaceutical manufacturers for deceptive and misleading insulin price increases. In May 2019, Connecticut and 43 other states filed a lawsuit against 20 of the nation’s largest generic drug manufacturers, alleging a conspiracy to artificially inflate and manipulate prices. NASHP is following these cases closely.
Why did you choose to introduce a bill to address insulin costs?
My little brother had type 1 diabetes, so I know about what it means to have to rely on insulin on a daily basis to stay alive. Over the last six or seven years, insulin costs have become more of a national story, and during my first years as a legislator, I wanted to figure out a way to reduce insulin prices. In 2018, I introduced an insulin price transparency bill that passed the House but died in the Senate. Coming back last year, I knew I wanted to continue to work on the transparency issue, but I also wanted to do something that could immediately help Coloradans by lowering the cost of insulin. That’s where I came up with the idea of an insulin cap.
How do you anticipate the insulin cap will impact Coloradans?
We have examples of people in this country who are spending anywhere from $300 to over $1,000 per month just on their supply of insulin, not including their medical supplies. Reducing those costs to $100 is going to mean a huge cost savings for Coloradans. That’s money in their pocket that they didn’t have before, which is the immediate effect of the bill.
What tools or authority does your bill give the attorney general?
Capping copays is only a first step, that’s why I put the attorney general piece in the bill. The law gives the attorney general investigative authority. Having the attorney general investigate insulin pricing and then submit a report to the legislature is going to be very valuable. It also allows the attorney general to request new authority to do something on the issue. There are attorneys general in other states who are filing lawsuits against insulin manufacturers, so that might be something for the Colorado Attorney General to consider as well.
Does the legislation have a mechanism for preventing cost-shifting to premiums? Was this a concern?
This was a concern when I drafted the bill, so we worked closely with the insurance companies
and arrived at $100 for the cap as the point where we could save money for people who need insulin without raising costs for everybody else on the same insurance plan. The insurance companies have said publicly that insurance prices won’t go up because of the cap.
What advice would you offer other states that want to enact similar legislation?
One piece of technical advice would be to make sure your bill is tightly written to avoid unintended changes during the rule-making process. For example, it should be clear that the cap refers to the total costs a patient would pay per month, not per insulin product per month, which would result in patients who take multiple insulins paying more than $100 a month.
I would also encourage lawmakers to work with all relevant stakeholders, including the insurance and pharmaceutical companies. In the end, even though there was opposition from the pharmaceutical industry and insurance companies, they were not active in lobbying against the bill. Compelling consumer testimony made it hard to vote against the bill.
I also think it’s important to recognize that this is only a first step with the potential for further action informed by the attorney general’s report. The cap alone is not a solution to the long-term problem. We need a national solution on drug prices, but if Congress isn’t going to step up, it falls to states to do something.
For comprehensive information about what every state legislature is doing to curb prescription drug costs, explore NASHP’s Rx Legislative Tracker.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
