'False promise' or lifesaver? Insulin spending cap returns to North Dakota Legislature

BISMARCK — A bill introduced in the North Dakota House of Representatives could cap out-of-pocket insulin costs for some North Dakotans at $25 per month.

The bill also includes a monthly cap for insulin-related medical supplies of $25.

With insulin costing North Dakota residents billions of dollars each year,

House Bill 1114

would provide relief for people on fully insured plans provided by individual, small and large group employers. People on self-funded plans would not be affected.

“I call insulin liquid gold,” Nina Kritzberger, a 16-year-old Type 1 diabetic from Hillsboro, told lawmakers. “My future depends on this bill.”

HB 1114 builds on

legislation

proposed during the 2023 session that similarly sought to establish spending caps on insulin products.

Before any health insurance mandate is enacted,

state law

requires the proposed changes first be tested on state employee health plans.

As such, the legislation was altered to order the state Public Employees Retirement System, or PERS, to introduce an updated bill based on the implementation of a $25 monthly cap on a smaller scale.

The updated bill — House Bill 1114 — would bring the cap out of PERS oversight and into the North Dakota Insurance Department, which regulates the fully insured market but not the self-insured market.

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.

“It (the mandate) doesn’t impact the entire insurance market within North Dakota,” PERS Executive Director Rebecca Fricke testified during a Government and Veterans Affairs Committee meeting on Thursday, Jan. 9.

Blue Cross Blue Shield Vice President Megan Hruby told the committee that two-thirds of the provider’s members would not be eligible for the monthly cap, calling the bill a “false promise.”

“We do not make health insurance more affordable by passing coverage mandates, as insurance companies don’t pay for mandates. Policy holders pay for mandates in the form of increased premiums,” Hruby said.

She touted the insurance provider having already placed similar caps on insulin products and said companies should be making those decisions, not the state government.

Sanford Health and the Greater North Dakota Chamber also had representatives testify against the bill.

Advocates for the spending cap said higher premiums are worth lowering the cost of insulin drugs and supplies.

“One of the first things that people ask me about is, ‘Why should I pay for your insulin?’ And my response is, ‘Why should I have to pay for your premiums?’” Danelle Johnson, of Horace, said in her testimony.

If adopted and as written, the spending caps brought by

House Bill 1114

would apply to the North Dakota commercial insurance market and cost the state around $834,000 over the 2025-27 biennium.

According to the 2024 North Dakota diabetes report,

medical fees associated with the condition cost North Dakotans over $306 billion in 2022.

The state has more than 57,200 adults diagnosed with diabetes, and a staggering 38% have prediabetes — a condition where blood sugar levels are high but not high enough to cause Type 2 diabetes.

Nearly half of those people are adults 65 years old or older.

North Dakotan tribal members were also found to be twice as likely to have diabetes compared to their white counterparts.