North Dakota Caps Insulin Costs at $25 for Insured Residents

Patients with Type 1 diabetes in North Dakota will now pay a maximum of $25 per month for insulin. This limit applies to individuals covered by state-regulated health plans, regardless of their deductible status. The new rule shields patients from high out-of-pocket costs that previously reached hundreds of dollars monthly.

The legislation passed the state legislature last year. It was co-sponsored by Republican state Sen. Sean Cleary and Democratic state Sen. Tim Mathern. Mathern, one of only five Democrats in a 47-seat Senate, noted the political difficulty of the proposal. “One is very lonely being a Democrat,” Mathern said, “especially if you espouse the more progressive end of public policy.”

The push for caps began as a Democratic initiative. Colorado enacted the first state-level insulin copay cap in 2019, limiting costs to $100 for a 30-day supply. In 2022, President Joe Biden signed a federal law capping insulin costs at $35 per month for Medicare beneficiaries. That federal cap did not extend to those with private or employer-based insurance.

North Dakota’s measure addresses the gap for those with private coverage. Before the cap, average out-of-pocket costs for privately insured patients with diabetes fell from $470 in 2018 to $220 in 2025, according to federal data. Despite this decline, families like the Kritzbergers in Hillsboro still report annual out-of-pocket expenses of at least $8,000 for drugs and supplies.

Nina Kritzberger was diagnosed with Type 1 diabetes at age 7. Her mother, Ang Kritzberger, described the financial strain on their farm, which grows sugar beets, soybeans, and grains. “We’re in an incredible amount of debt,” Ang Kritzberger said. The family travels to Bismarck to testify in support of such measures, often facing opposition from industry lobbyists.

Blue Cross Blue Shield of North Dakota argued that mandated coverage would raise premiums for all policyholders. Lobbyist Megan Hruby told lawmakers, “We do not make health insurance more affordable by passing coverage mandates.” AARP lobbyist Janelle Moos said many Republican lawmakers initially viewed the bill as excessive government regulation. “It wasn’t the role of government,” Moos reported hearing from GOP colleagues.

Supporters countered that a similar cost limit for state employees had little impact on premiums. They also cited widespread frustration with drug pricing. Cleary questioned why consumers pay high prices for a drug available for a century. “This market seems so broken and these families are having to make impossible decisions about rationing medication or skipping treatment,” Cleary said.

The bill passed with bipartisan support. State Rep. Carrie McLeod, a Republican and diabetes educator, stated that the insurance industry had lost sight of its original purpose. “Things have gotten out of control,” McLeod said. North Dakota is now one of 29 states with an insulin price cap.

The state cap does not apply to plans regulated by the federal government, which covers many large employers. A national insulin price cap is currently under consideration in Congress. Sen. Kevin Cramer, a North Dakota Republican, is among the bipartisan co-sponsors of that federal proposal.

A KFF survey conducted earlier this year found that 7 in 10 U.S. adults believe the government does not do enough to limit prescription drug prices. The sentiment is shared across party lines, with 68% of Republicans and 77% of Democrats agreeing. The North Dakota law takes effect as part of the state's standard legislative cycle for 2026.