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Committee weighs extending PERS insulin cap to commercial plans as proponents cite lives saved and insurers warn of market costs
Summary
Supporters urged the committee to extend a $25 monthly cap on insulin and certain diabetic supplies to commercially insured North Dakotans; the PERS board’s pilot found modest plan costs and member savings, while insurers warned the mandate could raise premiums or be redundant where caps already exist.
Representative Carrie McLeod presented House Bill 1114, a bill drafted by the Public Employees Retirement System (PERS) board to continue a $25 monthly cost-sharing cap for specified insulin products and diabetic supplies and to extend comparable coverage to the commercial market.
McLeod and multiple advocates described the cap as life-saving for patients dependent on insulin. They cited a PERS pilot directed by Senate Bill 2140: PERS extended a $25 cap for its active group plan during 2023–24 and PERS staff and consultants reported limited utilization changes and measurable per-member savings while estimating a modest premium impact to continue the benefit in PERS plans.
Rebecca Fricke, executive director of the North Dakota PERS, told the committee the pilot (July 1, 2023–June 30, 2024) produced an estimated member savings of about $80.15 per affected member per month in the pilot year, and Deloitte priced continuation of the benefit for the 2025–27 biennium at roughly 0.12% of premium for PERS plans (fiscal note). Fricke said the insurer (Sanford Health Plan) found many diabetic supply claims cost less than $25 per month, and drug manufacturers reduced list prices for insulin during the pilot, which reduced the plan’s total reimbursements.
Patient advocates described real-world harms from high insulin costs and rationing. Several witnesses and patients told the committee that people had rationed insulin because of price and that rationing leads to dangerous outcomes and costly emergency care. Matt Prokop of the American Diabetes Association and Angela Kritzberger of advocacy group Breakthrough T1D provided national and personal context for the proposal, noting that many states have enacted insulin caps and that federal Medicaid and Medicare rules already cap insulin cost-sharing for those respective populations.
Sanford Health Plan and Blue Cross Blue Shield of North Dakota opposed extending a state-mandated commercial cap. Sanford’s representative said manufacturers adjusted prices during the PERS pilot and warned of carrier exit or premium increases if the commercial cap is imposed broadly; Blue Cross emphasized that many commercial plans already include low insulin cost-sharing (some carriers already impose $5 or $25 caps) and said ERISA self-funded employer plans would not be subject to a state mandate.
Committee members questioned the size of the population affected and asked proponents for data. Representative McLeod and witnesses said the exact share of the state population affected by the mandate is uncertain; some estimates circulated during testimony suggested tens of thousands could be left out if they are in self-funded plans. Senators asked for more precise counts of people who currently ration insulin and for actuarial detail about premium impacts; witnesses promised to provide supporting data from the PERS report (the Novarest actuarial memo was attached to testimony).
Ending: The committee did not take immediate action and members asked for further data from the PERS report, carrier filings and estimates of affected populations. The PERS representative and advocates pressed lawmakers to extend the modest cap to more North Dakotans, while carriers urged caution and said many insured residents already enjoy low out-of-pocket costs for insulin.
