North Dakota Caps Insulin Costs for State-Regulated Insurance Plans

North Dakota enacted legislation last year to cap the monthly out-of-pocket cost of insulin for patients with state-regulated health insurance. The measure limits what these patients pay to $25 per month, regardless of high deductibles or other coverage requirements. This places the state in a group of 29 jurisdictions that have adopted similar pricing protections for diabetes medication.

The law was co-sponsored by Republican state Sen. Sean Cleary. He cited a broad agreement among lawmakers that the current market structure failed to serve patients effectively. Cleary noted that while Republicans generally favor free markets, this specific issue generated enough concern to warrant government intervention. The bill passed with overwhelming bipartisan support, a outcome driven by frustration with rising drug costs and insurance premiums.

The legislation responds to long-term price increases that forced many patients to ration medication. Federal data indicates that average annual out-of-pocket costs for privately insured patients with diabetes peaked at $470 in 2018. By 2025, that figure had declined to $220 following industry backlash against steep price hikes. Approximately one in five of the 40 million Americans with diabetes relies on insulin, a drug that has been commercially available for a century.

Opponents, including health insurers and the state chamber of commerce, argued that mandates would raise premiums for all policyholders. Megan Hruby, a lobbyist for Blue Cross Blue Shield of North Dakota, told lawmakers that passing coverage mandates does not make insurance more affordable. Janelle Moos, a lobbyist for AARP, reported that many Republican lawmakers initially questioned the role of government in setting prices. However, supporters presented evidence that a similar cost limit for state employees had little impact on premium rates.

Democratic state Sen. Tim Mathern, one of five Democrats in a 47-member Senate, led the legislative effort. He faced an uphill battle in a chamber dominated by Republicans but found common ground with colleagues who felt the healthcare system had become overly focused on profit. Representative Carrie McLeod, a Republican and diabetes educator, stated that the system had drifted from its original purpose of helping people with catastrophic needs.

The state cap applies only to plans regulated by North Dakota. Coverage provided by large employers typically falls under federal jurisdiction, meaning many residents may not see immediate changes to their bills. A national cap is currently under consideration in Congress, with co-sponsors including Sen. Kevin Cramer, a North Dakota Republican. A KFF survey from earlier this year found that 68% of Republicans and 77% of Democrats support stronger government regulation to limit prescription drug prices.