Pennsylvania committee hears divergent testimony on House Bill 305 to cap insulin copays at $35
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Summary
The House Insurance Committee heard personal and clinical testimony urging passage of House Bill 305 to cap a 30‑day supply of insulin at $35, while pharmacy benefit managers and insurers warned a universal cap could shift costs to insurers and raise premiums without addressing high list prices.
The House Insurance Committee met to consider House Bill 305, which would cap patient cost sharing for a 30‑day supply of insulin at $35. Testimony on both sides highlighted the stakes for patients, clinicians and the insurance market.
Rep. Jean McNeil, the bill's prime sponsor, told the committee she has worked on insulin affordability for about eight years and introduced HB 305 to ensure “a 30 day supply of insulin at $35 for all Pennsylvanians.” She framed the proposal as a life‑saving measure to prevent rationing and avoidable complications.
Patient testimony underscored those harms. Colleen Wynne described community members who ration insulin and the personal aid she provides: “I urge this committee to pass meaningful insulin cost capping legislation. Do not let luck be the determining factor in whether a Pennsylvanian survives tonight.” Wynne told lawmakers that retail vial prices can reach hundreds of dollars and that sharing and informal aid have become a last resort when insurance and manufacturer assistance fall short.
Clinicians and the state’s diabetes advocacy group backed the cap. Dr. Ajay Rao, section chief of endocrinology, diabetes and metabolism at the Katz School of Medicine at Temple University, described clinical consequences when patients ration insulin — repeated hospitalizations, preventable complications and compromised outpatient care — and recommended a predictable cost cap: “A predictable predictable manageable monthly cost cap, such as the 1 proposed here, can prevent dangerous rationing, reduce medical emergencies, and support better long term health outcomes.”
Monica Bilger, director of state government affairs for the American Diabetes Association, said the ADA strongly supports HB 305 and cited survey findings that many Pennsylvanians report rationing or spending hundreds of dollars each month on diabetes care. She also noted that 29 states and the District of Columbia have adopted insulin out‑of‑pocket caps.
But pharmacy benefit managers (PBMs) and insurers urged caution. Michelle Crimmins of Prime Therapeutics, a PBM, said a review of Prime claims showed "more than 90% of the claims had members paying $35 or less per month for their insulin," and argued the bill would not address uninsured people or the underlying high list prices of some products. Crimmins spotlighted Afrezza, a newer inhaled insulin product, as an example of a high‑cost item with limited competition.
Megan Barber, executive director of the Insurance Federation of Pennsylvania, said insurers share the goal of affordability but warned that a universal $35 cap could transfer the cost of rising list prices onto insurers and, ultimately, policyholders. Barber said the bill’s removal of tiered cost sharing would weaken insurers’ ability to steer patients to lower‑cost products and could put upward pressure on premiums and benefit design. She urged the committee to consider alternatives that target list prices directly, such as manufacturer transparency, caps on list prices, bulk purchasing, or stronger support for biosimilars.
Committee members questioned witnesses on several operational issues: whether commercially produced insulin differs from biologic insulin (witnesses explained that current market insulins are recombinant products), how prior authorization and formulary changes affect continuity of care, whether list prices rose after federal caps, and whether PBMs contractually use spread pricing. Witnesses said prior authorization delays and formulary shifts are common and can disrupt care; Prime said spread pricing is contractual with plan sponsors and disputed that Prime intentionally profits from spread pricing on insulin claims.
The committee did not take a vote during the hearing. Chairman Warren thanked the witnesses, noted staff transitions, and adjourned the meeting with no further business. The bill will move forward to the committee’s consideration process, where members signaled they may explore additional options that directly address list prices alongside patient cost‑sharing protections.
