North Dakota Senate sends bill on insulin caps to governor's desk

The North Dakota Senate passed a bill Tuesday that would cap the cost of insulin in the state.

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Sen. Sean Cleary, R-Bismarck, speaks on House Bill 1114, focused on individual and group health insurance coverage of insulin drugs and supplies, at the North Dakota State Capitol on Tuesday.

House Bill 1114 caps the out-of-pocket cost of both insulin and related medical supplies at $25 each per month and would apply to people on fully insured plans provided by individual, small and large group employers, not those on self-funded plans.

Employers that provide self-insured health programs use profits to cover claims and fees, acting as their own insurers. Fully insured plans refer to employers that pay a third-party insurance carrier a fixed premium to cover claims and fees.

The bill is an extension of a pilot project passed during the 2023 legislative session that imposed a $25 cap on insulin and related medical supplies for those insured through the Public Employee Retirement System (PERS).

The bill’s carrier Sen. Sean Cleary, R-Bismarck, said the pilot program showed “clear results.”

He said the average member impacted by it saved approximately $80 per month on their insulin supplies and the cost came out to approximately $2 per member of PERS per month. The cost to expand the program for the commercial market is estimated by actuaries to be even smaller, according to Cleary, somewhere between 30 cents and $1 per member of an insurance group, per month in the commercial market.

He said that approximately 300-400 North Dakotans in the large group insurance market will have access to affordable insulin under the bill.

“Fundamentally, this bill is about making sure that North Dakotans aren't paying hundreds of dollars a month for a drug that has been commercially available for over a century,” Cleary said.

The program would cost the state roughly $834,000 for the 2025-27 biennium.

Commercial market members, such as Blue Cross Blue Shield of North Dakota, have opposed the bill, saying high drug costs are a “system problem” and arguing that companies should be making the decisions on price caps, not the state government.

Sanford Health and the Greater North Dakota Chamber have also opposed the bill.

Proponents of the bill have argued that a small increase on the premiums is worth lowering the cost of insulin drugs and supplies.

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Sen. Tim Mathern, D-Fargo, speaks on House Bill 1114, focused on individual and group health insurance coverage of insulin drugs and supplies, at the North Dakota State Capitol on Tuesday.

The bill’s sponsor Rep. Carrie McLeod, R-Fargo, said on the House floor that a vial of insulin costs upwards of $360 for North Dakotans, meaning many spend close to $1,000 per month on the medication. This high cost can result in diabetics missing their treatments or rationing insulin.

Cleary said on the Senate floor that “Rationing insulin, missing treatment can lead to kidney failure, amputations, blindness, heart attacks, strokes and in some cases, death. I try not to be dramatic when I present bills in front of this chamber, but that's the reality for folks who miss treatment because of insulin (costs) or have to ration their medication.”

The bill previously passed the House in a 59-27 vote and passed in the Senate with a 39-7 vote. It now goes to the governor for his signature or veto.

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