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House passes insulin cost‑cap bill after debate on mandates and costs
Summary
The House approved a bill capping monthly out‑of‑pocket costs for insulin and related supplies for covered plans after members debated costs, PBM practices and likely fiscal effects. The final vote was 59–27 in favor.
The North Dakota House passed House Bill 11‑14, a measure to limit monthly out‑of‑pocket costs for insulin and related supplies, on a 59–27 final vote.
The bill, introduced by the Government and Veterans Affairs Committee at the request of the Public Employees Retirement System (PERS), would require health benefit plans to cap a covered individual's cost for a 30‑day supply of covered insulin at no more than $25 per pharmacy or distributor and to cap covered insulin dosing and administration supplies at a total of $25 per pharmacy or distributor for a 30‑day supply. The committee reported a fiscal note prepared by PERS estimating general‑fund expenditures of $365,100 and other funds expenditures of $468,800 in the 2025–27 biennium; the same amounts were projected for 2027–29.
Debate on the floor was lengthy and included health‑policy, fiscal and personal‑story arguments. Representative McLeod described constituent hardships and cited Federal Trade Commission findings on insulin price increases; she referenced actuarial work by Novarest and a PERS pilot indicating modest per‑member cost impacts. Other members urged caution about imposing mandates on the commercial market, arguing mandates may raise premiums for small businesses and that private insurers already provide caps for some market segments. Representative Wagner (Appropriations) noted that the PERS pilot and commercial provider caps lower the projected cost impact and cited Novarest estimates of roughly $0.30 to $1 per member per month for the commercial market if coverage were extended broadly.
The House approved HB 11‑14 on final passage, 59 yea, 27 nay. The bill text and committee reports reference PERS actuarial analyses and a projected limited premium impact; members stressed differing priorities between immediate cost relief for patients and broader insurance market implications.
Why this matters: The measure directly affects patients who use insulin and related supplies and would lower immediate cost barriers that can drive rationing. Supporters argued the cap would reduce serious health harms; opponents cautioned about mandate effects on premiums and the commercial market.
Fiscal note and implementation: The PERS fiscal note was presented on the floor; the committee reported an estimated biennial cost (PERS/other funds) in the hundreds of thousands. Sponsors cited insurer and actuarial estimates that projected small per‑member premium increases if the benefit were extended to commercial markets.
Ending: HB 11‑14 passed the House and will proceed to the Senate for consideration. The floor record does not show any immediate amendments beyond committee‑reported language.
