Minnesota Governor Signs Emergency Insulin Law

Alicia Ault

April 15, 2020

Minnesota Governor Tim Walz has signed into law a bill that will require manufacturers to make available at least a 30-day supply of insulin to those who are in urgent need and cannot afford the medication, less than 24 hours after it was approved by the state legislature.

Walz, of the Democratic-Farmer-Labor Party, signed the Alec Smith Insulin Affordability Act on April 15 during a Facebook live stream.

The bill is named for a young man who died in 2017 after rationing his insulin.

"A lot of blood, sweat, and tears went into this bill," said Alec's mother, Nicole Smith-Holt, after the House and Senate votes.

Smith-Holt has been an outspoken critic of the cost of insulin, working as a leader in the #insulin4all campaign organized by T1International, and even getting arrested in September 2019 during a protest against insulin prices at Eli Lilly in Indianapolis.

"This bill is a HUGE win for ppl who can't afford insulin," tweeted fellow #insulin4all advocate Quinn Nystrom, who is running for a US congressional seat in Minnesota. "This took us 3 yrs & many passionate diabetes advocates that wouldn't take no for an answer," she said in the tweet.

People with diabetes will be eligible for a 30-day supply initially and up to a 90-day supply of emergency insulin if they are a Minnesota resident. They must not be enrolled in the state Medicaid or other low-income health programs or have drug benefits that limit copays to less than $75 a month. They cannot have received emergency insulin within the past year. The dispensing pharmacy is allowed to collect up to a $35 copayment for a 30-day supply.

The bill requires insulin manufacturers provide insulin to the program at no cost or to reimburse pharmacies that provide it to participants. Manufacturers will be fined $200,000 per month for not complying. The figure rises to $400,000 a month after 6 months.

The companies "have millions of dollars at stake if they do not comply with this program," said Smith-Holt.

But insulin makers may eventually challenge the law.

PhRMA, the drug industry trade association, said it believes that requiring manufacturers to provide free insulin could be unconstitutional, according to the Minneapolis StarTribune.

States Capping Copays

Meanwhile, a growing number of states are taking action against the cost of insulin by requiring a cap on copayments for the medication.

Capping copays has become a popular response. Medicare announced in March that it was proposing a test program starting in January 2021 that would limit the copay for most insulin types to $35. But insurer and manufacturer participation is voluntary, not required.

Eli Lilly limited copays for most of its insulins at $35 in April, but individuals with Medicaid, Medicare, Medicare Part D, or any state patient or pharmaceutical assistance program are not eligible, in response to the COVID-19 pandemic, according to the company.

Colorado was the first state to take action, enacting a $100 cap in May 2019. Since the beginning of 2020, eight states have followed: Illinois, Maine, New Mexico, New York, Utah, Washington, Virginia, and West Virginia.

Virginia was the latest. Governor Ralph Northam (D) signed his state's cap into law on April 12. Beginning January 1, 2021, health insurers will be limited to charging $50 for a month's supply of insulin.

The American Diabetes Association (ADA) said it supported that bill as well as legislation in the other states. Most of the laws take effect January 1, 2021.

In March, New Mexico enacted the lowest cap: $25. Utah is capping the copay at $30. The Utah law also lets people whose prescriptions have expired receive an emergency refill, according to the ADA.

Maine capped copays at $35. The copay applies even before a plan's deductible is met, and the state also allows for emergency refills.

Illinois, New York, Washington, and West Virginia have capped copays at $100 for a month's supply. In Washington and New York, the copay applies even before the deductible is met, and is supposed to be counted towards the deductible.

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