Colorado will become the first state to cap total out-of-pocket spending for insulin after state lawmakers OK’d legislation limiting monthly copays to $100 per month for insured residents.Other states are considering similar approaches to insulin coverage, and that ultimately will cause the costs to be passed on to payers, says Ashraf Shehata, principal and healthcare leader at KPMG LLP in Cincinnati.“It’s like squeezing a water balloon,” where the cost is shifted from one place to another but someone still needs to pay, Shehata tells AIS Health. “Whatever the state mandate is, the insurance company will have to comply, and that’s passed on to payers. There is a point where you can’t push it downstream any further.” This could lead to pressure on manufacturers, plus a broader discussion surrounding the cost of diabetes care, he says.
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