MD’s insulin price cap just went into effect; here’s what you need to know

MARYLAND – With the new year comes savings for certain Marylanders who rely on insulin.

Saving Lives, Saving Money

The Insulin Cost Reduction Act, signed by Governor Larry Hogan last year, went into effect on January 1st, 2023. It limits co-payment and co-insurance amounts for prescription insulin drugs. The legislation requires insurers, non-profit health service plans, and health maintenance organizations to cap insulin at $30 for a 30-day supply.

The cap could prove to be a lifesaver for those who rely on insulin, say local pharmacists.

“There were a lot of people before this that had very big bills, and could not afford their insulin,” said Apple Discount Drugs pharmacist Matthew Balish. “When you go without your insulin, it’s not good for you, and it’s not good for the health care system. You are sicker because you don’t get your insulin, you could have strokes, heart attacks, problems with your eyes, problems with the nerves in your legs or fingers.”

Reducing Stress on Health Care System

Balish says it’s not just individuals who could stand to benefit from insulin becoming more affordable.

“By providing insulin, you’re keeping people out of the hospitals, and you’re saving money in other areas of health care. An emergency room visit because you don’t have insulin, or you’re rationing it because you can’t afford it, costs more money in that silo of health care than it would be if they just paid for the insulin,” said Balish. “By capping monthly insulin at $30, you’re giving them access to this life-sustaining medication, and theoretically, that’s going to pay dividends elsewhere with reduced morbidity and mortality.”

Prepare For Payments

But even though those savings are on the way, the effects might not be immediate. Balish says it’s important for Marylanders to know that it could be a few months before they actually pay $30 monthly for insulin.

“There is a 90-day grace period from January 1st. So, you may come to the pharmacy, and you still may be hit by that high deductible, high co-insurance. The insurer then has to reimburse you within those 90 days,” said Balish.

Balish says pharmacies don’t have the ability to change co-payments or co-insurance costs. So, reimbursements will come directly from patients’ insurance companies to them. He encourages anyone with questions about their billing to contact their insurance company.

“It’s not something the pharmacy is going to be able to [change]. We can’t adjust co-pays. It’s something that’s done electronically, and we are just, unfortunately, the middle man in this whole process,” said Balish. “In January, everybody has sticker shock because deductibles reset, co-insurance resets, your insurance plan is in a new year. So, if you go to the pharmacy and you’re on a branded medication, and you have some sort of deductible, be ready for that.”

Categories: Health, Local News, Maryland, Money