For the coming 2020 legislative session, House Health Committee chairman Rep. John Mizuno plans to introduce a bill that would help local diabetics by capping the price of a 30-day supply of insulin at $100.

Insulin, a hormone produced by the body’s pancreatic islets, is critical for cellular absorption of glucose. Because diabetics either do not produce enough insulin or are resistant to the amount their pancreas naturally generates, toxic levels of glucose – “blood sugar” – can accumulate in their bodies, resulting in organ failure, and eventually, death.

Though treatment for diabetes dates as far back as 400 to 500 A.D. when the Indian physician Sushruta and the surgeon Charaka first discovered Type 1 and Type 2 diabetes, it was not until 1922 that insulin replacement was available as a medical treatment.

For a century, the lives of diabetics have depended on insulin. But unstable prices have lawmakers worried.

Danny de Gracia/Civil Beat

Leonard Thompson, a 14-year old Type 1 diabetic admitted to Toronto General Hospital on January 11, 1922, is the first recorded patient to have received successful insulin medication, when after several series of injections, his blood sugar dropped from 520 milligrams per deciliter to 120 mg/dL.

Thompson’s case was a medical breakthrough, and in 1923, short-acting insulin production began in Denmark and Austria. Today, some 40 manufacturers in 55 different countries produce over 1,985 insulin products across the globe.

While this may seem like a lot, access to affordable insulin is getting increasingly difficult.

The wholesale price of insulin has skyrocketed over the last decade, and while the U.S. market accounts for only 15 percent of the total insulin users, 50 percent of worldwide insulin revenues are made in America. Price gouging in the pharmaceutical market is commonplace, and minimal competition allows companies to charge almost any price they please.

The Centers for Disease Control and Prevention (CDC) recently found that women and uninsured persons were likely to ration – underuse – their insulin and other diabetes medications as a cost-saving strategy.

The American Diabetes Association Board of Directors convened an Insulin Access and Affordability Working Group in 2017, and concluded, “People with diabetes are financially harmed by high list prices and high out-of-pocket costs.” This is especially problematic, because in the case of Type 2 diabetes, it disproportionately affects persons of lower socioeconomic status.

According to America’s Health Rankings, in 2018, almost 1 out of every 10 persons in Hawaii had diabetes. In Hawaii, where locals already spend so much on the cost of living, diabetes can be an expensive disease to manage, so wild mood swings in both the economy and the pricing of insulin could be deadly for locals.

Horror stories of persons on the mainland paying as much as $1,300 for a month’s supply of insulin has spooked some policymakers. Mizuno said by phone that he believes Hawaii should follow in the footsteps of Colorado by placing a ceiling on the price of insulin.

Mizuno’s bill, which affects Title 24 of the Hawaii Revised Statutes, would require insurance providers to cap the price of insulin co-payments at no more than $100, “regardless of the amount or type of insulin needed to fill the insured’s prescription.”

“The bottom line is these drugs should be made affordable,” Mizuno said.

Warning that persons who ration insulin because they can’t afford the co-pay eventually end up in emergency rooms which raise the overall cost of medical care for everyone, Mizuno believes that capping the price of insulin to allow better diabetes management is a common sense solution.

Rep John Mizuno introduces guests in the gallery during floor session on March 21, 2018.

Rep. John Mizuno wants the Legislature to cap the price of insulin at $100 for a 30-day supply.

Cory Lum/Civil Beat

As a point in case, in 2016 one of my cousins, a Kaneohe resident who was a Type 1 diabetic, died in the emergency room because of out-of-control blood sugar. Type 1 diabetics can easily experience life-threatening complications even under controlled conditions, but neglecting medication can be fatal.

“There’s a strong humanity component to this bill,” Mizuno says, suggesting that this is just one approach to the crisis.

“I wonder if the state attorney general should look into the pharmaceutical companies to see why the prices are so high. If our state investigates why they are charging so much for insulin, that could open up a whole number of legal actions, similar to what we’re seeing with the opioid crisis with Oklahoma winning [$572 million] dollars in a settlement in the court case.”

In Minnesota last year, their state sued pharmaceutical companies over the price of insulin, alleging fraudulent practices where artificially high list prices were set for insulin products. But then lower prices were negotiated to pharmacy benefit managers.

When asked what other legislators might think about his proposal, Mizuno said that the health committee members are very independent, and it might take some effort to convince them and the Legislature as a whole to get on board with the concept.

But he believes that once the public is informed more about the crisis, there could be a groundswell of support. Still, he wants Hawaii voters to know they need to speak up for what’s right.

“The pharmaceutical companies are not (going to) be happy,” Mizuno cautioned. “For them, as well as anyone else involved in making any type of profit, I’m going to be public enemy number one and they will have a strong lobbying effort to kill a bill like this.”

Read a copy of Rep. John Mizuno’s draft legislation for capping insulin prices:

Before you go . . .

During a crisis like this, it’s more important than ever to dig beyond the news, to figure out what government policies mean for ordinary citizens and how those policies were put together.

For the first time, Civil Beat has become a seven-days-per-week news operation, publishing new stories and a new edition each Saturday and Sunday as well as weekdays.

This is perhaps the biggest, most consequential story our reporters will ever cover. And at no other time in Civil Beat’s history have we relied on your support more. Please consider supporting Civil Beat by making a tax-deductible gift.

About the Author