BISMARCK — A bill that would have capped the upfront cost of insulin at $25 for residents with a North Dakota insurance plan is a shell of its former self after changes by lawmakers.

Senate Bill 2183 garnered strong objections to its attempt to make insulin affordable for people with diabetes. Some diabetics require insulin — a hormone the body uses to allow blood sugar to be made into energy — in order to survive. The cost of insulin has increased significantly over the past decade, with the average price of a prescription doubling from $344 in 2012 to $666 in 2016, according to the Health Care Cost Institute.

The original version of the bill would have put a $25 cap on the amount a person with a North Dakota health insurance plan pays in either copay or coinsurance when picking up insulin at a pharmacy or distributor. The health insurance company would have shouldered the rest of the cost.

But at a Senate Human Services Committee meeting earlier this month, senators amended the bill because they were concerned about its costs for providers, stating that it would do nothing to really lower the overall cost of insulin and it would be a "slippery slope" for setting price caps on other medications.

As the amended bill stands now, only residents enrolled in the North Dakota Public Employees Retirement System (NDPERS) would qualify to obtain a 30-day supply of insulin with a maximum copay or coinsurance of $25. After two years of piloting this effort, legislators would analyze the costs incurred by the plan and then decide whether to apply it to other insurance plans.

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An estimated 15,300 North Dakotans with diabetes require insulin medication, many of whom are on state insurance plans.

Almost 700 members under the state employee retirement system filed claims for insulin in 2020, according to Daniel Weiss, Sanford Health Plan's senior executive director of pharmacy.

The bill is expected to be heard this week on the Senate floor where many lawmakers are anticipating an extensive discussion.

Along with concerns about the bill acting as a catalyst for capping other medication prices, the Senate Human Services Committee opted to have the $25 copay apply to people in the NDPERS program because state law says an insurance mandate must be administered to the state's public employee retirement system and undergo a cost-benefit analysis before it's applied to other plans.

But Sen. Tim Mathern, D-Fargo, who drafted the original bill, said this requirement can easily be overridden by changing the language of the bill, which is why he intends to propose an amendment that would revert the bill back to its original form that applies the copay and coinsurance cap to other North Dakota insurance plans.

Mathern said this issue needs to be addressed right now and is not a matter of economics but of life and death. Many lawmakers have concerns about the bill being "a slippery slope," but Mathern said, "The slippery slope is going in the right direction, and the direction is that everybody is getting the health care they need."

Some insurers in North Dakota, like Blue Cross Blue Shield already have $25 insulin copays for certain plans — something lawmakers also cited as a reason to change the bill.

The discussions about the bill this month have been frustrating for many of its supporters.

Hillsboro, N.D., resident Angela Kritzberger has paid up to $1,200 for a 30-day insulin prescription for her 12-year-old daughter who lives with Type I diabetes.

"Insulin is a preventative measure. It prevents death," Kritzberger said.

Proponents of the bill back the amended version, but they wish it would apply to all North Dakota insurance plans. Kritzberger said the bill needs support now because if the Senate votes it down, it will be killed and fewer people will continue talking about diabetes.

"This has a whole different meaning when you say you're going to kill a bill, because here it literally means that it's costing people's lives," she said.

Readers can reach Forum reporter Michelle Griffith, a Report for America corps member, at mgriffith@forumcomm.com.