As insulin prices soar, Washington lawmakers weigh price caps and importing drugs from Canada

OLYMPIA — With continued anxiety over the high cost of prescription drugs, Washington lawmakers Friday heard public testimony on bills aimed at lowering prices, including two ideas to get cheaper medication from Canada.

The bills are a part of Democratic Sen. Karen Keiser’s package, some of which specifically target prices for insulin.

According to the state Department of Health, diabetes is the seventh leading cause of death in the state, with about 686,000 people diagnosed. People of color, those in rural counties, and less-educated individuals are more likely to be impacted by the disease.

The American Medical Association reports that the price of Humulin R, a common insulin marketed by Eli Lilly, increased in price by more than 500% from 2006 to 2015. The crisis is pushing more and more Washingtonians to travel to Canada to get the life-saving medication for significantly cheaper.

“The federal government is totally inactive and unable to function,” the Des Moines senator said. “So the states have to step up.”

Those who testified in favor of Keiser’s proposals ranged from diabetics to retired doctors and pharmacists. Amber Markland, a small business owner in Olympia, brought her diabetic 8-year-old son with her, along with a vial of insulin, which she said cost $300.

“That’s $900 per month, minimum,” Markland said. “Levi doesn’t get a choice. Without insulin, he dies.”

Levi followed his mother, telling the committee, “My life shouldn’t be a burden to my family.”

Keiser’s bill package takes a broad approach to the drug affordability crisis, and includes the following pieces of legislation.

• SB 6087, establishing a cost-share requirement so that out-of-pocket expenses are limited to $100 for a month’s supply of insulin. 
• SB 6088, establishing a drug affordability board that could set price limits for state purchased health care programs.
• SB 6110, establishing a program to import cheaper prescription drugs from Canada.
• SB 6111, creating a program to reimburse state employees for trips to Canada in order to purchase cheaper prescription drugs.
• SB 6113, establishing a centralized state insulin purchasing program.

Keiser says her bills are modeled after similar programs in other states, including Utah, which pays for its public employees to travel to Tijuana, Mexico, or Vancouver, B.C., in order to fill their expensive prescriptions. She also cited Colorado, which put a $100 cap on insulin co-pays last year.

Supporters of the bill called out the three major insulin producers — Sanofi, Eli Lilly and Novo Nordisk — for dominating the market and setting crippling prices.

Kevin Wren, a diabetic and insulin advocate, said insulin companies have “exploited a disability to the tune of billions and billions.”

Wren told the committee that after he was laid off, he was forced to ration insulin and borrow from his father’s supply. Without that relationship, he said he may have died.

In an interview before the hearing, Keiser said she had “no illusions” about the obstacles Democrats will have in Washington state, noting that the pharmaceutical industry is “one of the wealthiest and most difficult lobbyist groups to work with and work around.”

Representatives from Kaiser Permanente, the Association of Washington Healthcare Plans (AWHP) and the Biotechnology Innovation Organization (BIO) opposed Keiser’s bills.

Representatives from AWHP and BIO argued against SB 6088’s potential to allow the state to “price fix,” a strategy they said “despite good intentions, rarely actually work,” and may stifle innovation by limiting the free market. 

Courtney Smith, a spokesperson for Kaiser Permanente, argued that co-pay price caps would fail to mitigate increasing drug prices, and would force insurance carriers to absorb the increased costs.

Committee members fired back, insisting that foreign countries, including Canada, have implemented similar policies successfully.

Those who were opposed also brought up concerns that Canada may not be able to meet the state’s demand, and that foreign entities would not be subject to the United States’ regulations.

Fiscal statements for the five bills have not yet been completed, and the Senate’s lead budget writer, Christine Rolfes, D-Bainbridge Island, who is a co-sponsor on some of the bills, says it’s too soon in the session to assess their budgetary implications.

Even with a Democratic majority in both chambers, Keiser says it’s unlikely that all five bills will pass, but she hopes it will be the first step on a “very long and winding road.”

Correction: An earlier version of this story stated that Senate Bill 6111 would apply reimbursements to residents on trips to Canada to buy prescription drugs. In fact, the bill would apply to state employees.