Most people in the U.S. have health coverage that includes prescription drugs, but that does not always mean they are able to afford the specific medication they need. Increasingly, people who are insured must make “tough choices” that are not faced by those in other advanced nations. According to a recent National Public Radio poll, almost half of Americans who are affected by this problem simply forego their medications.

Meanwhile, as legislators in Washington D.C. continue to serve as lapdogs to the pharmaceutical industry or twiddle their thumbs as they whine about medical price gouging (primarily for their constituents’ benefit), state governments are stepping up. Two states – California and New York – currently have plans to force drug companies and pharmaceutical benefit managers (who are a large part of the problem) to keep the price of vital medications affordable. A third state, Wyoming, has developed a solution that allows patients who qualify under federal poverty guidelines to get some prescriptions for free.

In California, Governor Gavin Newsom proposed a plan that would make the Golden State the first to establish its own generic drug label. Although complete details of the plan will not be released until this spring, Newsom has stated that his office is already in negotiations. According to a story published earlier this month in the Sacramento Bee, Gavin’s proposal would establish a single market for the purchase of prescription medications, which would force drug companies to sell their products at the same price throughout the state. It would also require them to set their prices lower in California.

Wyoming is taking a novel approach that involves the recycling of prescription drugs. The Wyoming Department of Health operates a Medication Donation Program, which collects usable medications from patients who no longer require them. These recycled drugs are then used to fill prescriptions at no charge for those who otherwise could not afford them. The program has limitations; donations must be sealed, unexpired, and not require refrigeration.

New York is taking a multi-pronged approach that puts caps on co-pays while allowing the state Department of Financial Services more power in controlling spikes in drug pricing. It would also allow for the reimportation of prescriptions from Canada. Governor Andrew Cuomo’s plan is supported by several legislators in Albany. They also favor the expansion of New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) Program, which provides assistance for seniors. The New York Assembly also has a bill under consideration that would require pharmaceutical companies to inform the state Attorney General’s Office of any issues that might delay the production of generics.

Significantly, both California and New York’s health care proposals specifically address the skyrocketing price of insulin, a medication necessary for the survival of type-1 and some type-2 diabetics. According to an analysis published in the Journal of the American Medical Association, the cost of insulin for patients exploded by over 200 percent from 2002 to 2013, going from just over $230 to nearly $740 per vial. A bill recently introduced in the Washington State legislature would cap the cost for patients to $100 a month. Similar caps have already been imposed in Colorado and are under consideration in Illinois.

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K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.