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Heated hearing on insulin cap: advocates press for statewide coverage; insurers and business groups warn of mandate costs
Summary
Supporters urged lawmakers to extend a $25 monthly cap on covered insulin and diabetic supplies tested in a PERS pilot; insurers and the business community warned a statewide mandate on the commercial market would shift costs to employers and not affect self‑funded plans.
House Bill 1114, drafted to continue coverage first tested under a PERS pilot, drew extensive testimony for and against the measure in the House Government and Veterans Affairs Committee.
The bill would create a state insurance‑code provision mirroring the $25 monthly cap on covered insulin drugs and diabetic supplies that applied to the North Dakota PERS active group plan during a two‑year pilot (Senate Bill 2140). Rebecca Fricke, executive director of NDPERS, testified that PERS' pilot showed a modest plan‑level cost: the pilot's additional premium cost was 0.14% of premium and Deloitte projected continuing the coverage would cost roughly 0.12% of premium (about $1 million) for the 2025–27 biennium. Fricke told the committee the pilot produced estimated member savings of about $80.15 per affected member per month comparing year‑over‑year data and that plan reimbursements were lower after the cap in part because two manufacturers (Eli Lilly and Novo Nordisk) reduced list prices effective Jan. 1, 2024.
Proponents included patients and parents who described rationing, financial hardship and life‑threatening consequences when insulin is unaffordable. Danelle Johnson, a longtime state advocate and parent of a person with type 1 diabetes, said the policy goal is to "make insulin therapy accessible and affordable to everyone" and cited precedent in more than 25 states. Her daughter, 16‑year‑old Nina Kritzberger, testified about living with type 1 diabetes and urged the Legislature to act to avoid future deaths from rationing.
Opposition and concern came from the Greater North Dakota Chamber and major insurers. Andrea Fennig, vice president of government affairs for the Chamber, said employers oppose mandates that increase costs; she noted the PERS pilot showed little utilization change and argued the measure shifts costs to businesses. Insurers emphasized that state mandates apply only to the fully insured market (not to ERISA self‑funded plans) and said large portions of the market would not be affected. Megan Ruby of Blue Cross Blue Shield of North Dakota and Dylan Wheeler of Sanford Health Plan said they support affordable medications but oppose broad state mandates as an inefficient tool that can stifle plan innovation and raise premiums; Ruby noted federal and carrier actions already put caps in certain markets (for example, the federal Medicare cap of $35 per month). Crystal Bartuska of the Insurance Department proposed a technical amendment defining "health benefit plan" for placement in Title 26.1.
Testimony and committee discussion clarified which commercial plans would be affected if the bill passes: because the Insurance Department regulates the fully insured market, HB1114 as drafted would apply to large employer fully insured groups (typically 51+ employees), while individual and small fully insured markets already have insulin coverage language in the state benchmark. The Insurance Department and committee members said self‑funded employer plans are not subject to state mandates.
Committee members asked for additional analysis and amendments. The PERS board recommended continuing coverage in the PERS active health plans and offered the PERS pilot report and actuarial attachments; the board did not take a position on rolling the cap out to the broader commercial market. The committee did not vote on HB1114 at this hearing and referred the bill for further amendment work and possible subcommittee review.
