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Capping diabetes treatment costs helps PEIA

Kat Stoll Kat Stoll |


Jan 25, 2023

One thing that all health economists agree on is that it can take a small upfront investment in care to yield a large return in cost savings in our health system today. For example, investing in care and services for pregnant women can reduce premature births and other expensive pregnancy outcomes. Another example is investing in diabetes management.

In the latter category, I want to flag a state bill that can help West Virginians be able to afford to appropriately manage diabetes. The bill passed, with strong bipartisan support, the full House of Delegates and the Senate during last year’s legislative session. Sadly, with amendments left the approve, the bill didn’t quite make it across the finish line last year. I won’t get into the last-minute legislative mish-mash that left the bill without the necessary final vote in literally the last minutes of the 2022 legislative session.

But the good news is that the bill has been reintroduced this year as House Bill 2430 by Delegate Matthew Rohrbach, R-Cabell.

This diabetes copay cap bill would help West Virginians who have PEIA or private health insurance be able to afford the care they need to stay healthy, avoid expensive health complications and emergencies, and to stay working and productive.

HB 2430 would create reasonable patient out-of-pocket spending cost caps with an insulin copay cap of $35 per month (now $100 under current law); insulin supplies and equipment insurance copay cap of $100 per month; and an insulin pump copay cap of $250 for one pump every two years.

What is really important for our legislators to realize is that HB 2430 is an excellent way to improve the long-term financial stability of PEIA.

West Virginia legislators are correctly concerned about the future of the Public Employee Insurance Agency that provides affordable, quality health insurance to state and local workers. It is estimated that by state fiscal year 2027, PEIA will face a $376 million shortfall.

There are a lot of ideas circulating about how to reduce costs in PEIA. Most of them involve shifting costs on to the backs of state and local workers and retirees. It hardly makes sense to give them a raise with one hand and take away that raise with the other by hiking health insurance and care costs. The Legislature should accept that investments in PEIA are going to be necessary. (For example, there are bills on the table in the Legislature to increase provider reimbursement rates so that hospitals and other providers do not drop out of the PEIA network.)

The fiscal note on last year’s diabetes copay cap bill stated that it would cost PEIA $177,000 when fully implemented. That is a small but smart investment that could save PEIA much more money in just a few years. The fiscal note doesn’t tell the whole story. There are longer-term program savings that can be harder to quantify even if they are obvious.

Today sensors, monitors and automatic pumps more accurately deliver information on blood sugar levels and regulate insulin delivery. While modern supplies and equipment can greatly improve health and quality of life, many West Virginians simply cannot afford them. And the result is uncontrolled diabetes resulting in much higher long-term costs for PEIA and other insurers. Uncontrolled blood sugar levels can lead to trips to the hospital for hyperglycemia and hypoglycemia (serious high and low blood glucose or sugar levels), ulcers, infections, heart attack and acute kidney failure. Longer-term uncontrolled diabetes can result in blindness and limb amputations. And sadly, the results can even be more tragic: West Virginia has the highest diabetes mortality rate in the country.

Another missing piece of the fiscal note analysis are the indirect costs of West Virginians with diabetes facing barriers to successfully managing their health. Uncontrolled diabetes leads to huge workforce productivity losses including lost household productivity, inability to work, absenteeism — costing our state hundreds of millions of dollars annually. People with uncontrolled diabetes that causes health complications have significantly higher rates of absenteeism than people without diabetes.

According to the American Diabetes Association, 232,000 West Virginia adults (16%) have been diagnosed diabetes. It’s estimated an additional 45,000 West Virginians have diabetes but don’t know it, greatly increasing their health risks. Another 35% of West Virginia adults — like me — are currently diagnosed as pre-diabetic.

All West Virginians — regardless of our source of health insurance coverage — should be able to afford the basic tools that allow us to take care of ourselves and stay healthy. And if we want to control costs in PEIA, HB 2430 will do exactly that.

I urge our Legislature to move HB 2430 quickly this year. It meets the Republican legislative leadership’s own criteria for a bill to move under suspension of regular rules. It was fully vetted last year in the committees of jurisdiction and passed both chambers. It is time to get this done.

Kathleen Stoll is policy director for West Virginians for Affordable Health Care ( and operates a policy and economic consulting business, Kat Consulting

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Capping diabetes treatment costs helps PEIA
Capping diabetes treatment costs helps PEIA