St. Paul, MN – “For many Minnesotans, insulin is literally their lifeline,” said Sen. Matt Little (DFL-Lakeville) referring to the 320,000 Minnesotans with type 1 or type 2 diabetes, according to the Minnesota Department of Health. “The price of insulin has become a public health crisis. Ordinary folks can’t afford the sky-rocketing prices. We can’t sit by while so many are in danger.”
Sen. Little’s bills bring together a bipartisan, bicameral coalition, including: Sen. Jim Abeler (R-Anoka), Sen. Scott Jensen, M.D. (R-Chaska), Sen. Melissa Wiklund (DFL-Bloomington), Sen. Patricia Torres Ray (DFL-Minneapolis), Sen. Jim Carlson (DFL-Eagan), Sen. Melisa Franzen (DFL-Edina), Sen. Chris Eaton (DFL-Brooklyn Center), Sen. Jeff Hayden (DFL-Minneapolis), Sen. Matt Klein, M.D. (DFL-Mendota Heights), Rep. Michael Howard (DFL-Richfield), Rep. Laurie Halverson (DFL-Eagan), Rep. Sandra Masin (DFL-Eagan), and Rep. Alice Mann, M.D. (DFL-Lakeville).
The average price for vial of short-acting insulin increased an astounding 585% over the past 14 years, and the price for long-acting insulin rose from $170 to over $1400 for just one 20 ml vial, according to Truven Health Analytics. Quinn Nystrom, a respected diabetes advocate, reported paying $600 and $900 for her insulin vials and glucose monitor during Sen. Little’s December Insulin Roundtable. “For us to do nothing” Sen. Abeler commented in December, “In the face of what we’ve known for some time, would be just wrong.”
There are only 3 manufacturers of insulin in the U.S. and potential competitors have been blocked by a near monopoly, and by patent manipulations barring new formulations from entering the market. “A big part of the problem is the small number of insulin providers,” explained Sen. Little, “Making it really tough for people to find a cheaper alternative. Long term, we need to fix the market that made these shocking price-hikes possible. Short term, we’ve got to get emergency help for people who would otherwise die without access to the right kind of insulin.”
Alec Smith passed away in June 2017 at the age of 26 when he was forced to ration his insulin because he could not afford it. Alec’s mother, Nicole, spoke at Sen. Little’s December roundtable saying Alec was “not meant to leave this world so early in life, he was not meant to suffer a horrible, painful death.” Considering that diabetes was mentioned as a cause of death on 252,806 death certificates in 2015, Alec was far from alone.
Sen. Melissa Wiklund and Rep. Michael Howard will introduce the first bill, the Alec Smith Emergency Insulin Act, this week. The bill establishes a means for Minnesotans who are unable to afford their needed insulin to get their prescription filled on a temporary basis. The bill provides reimbursement for pharmacies through a fee on insulin manufacturers.
“Nicole and James are courageously sharing Alec’s story in the hopes it will drive real change, and it’s time for us to take action,” said Rep. Howard. “Never again should a Minnesotan lose their life because they cannot afford the insulin to survive.” Sen. Little agreed, “It’s not hard to see how this bill could have saved Alec’s life. No one should ever have to ration their insulin again.”
The second bill (SF366) ensures price transparency between insulin manufacturers, pharmacies and customers. “This bill is thorough” explained Sen. Wiklund, one of the bill’s co-authors, “It calls for the insulin manufacturers to justify and explain each price hike they propose so customers can actually understand why they’re being charged more.” Sen. Little added, “There’s a big lack of accountability right now and this bill will change that.”
The bill also calls for reports from pharmacy benefit managers and orders the Minnesota’s Health Commissioner to analyze the data and provide a report to the legislature. Price transparency was listed as one of the American Diabetes Association’s main recommendations for changes to the insulin industry in 2018. Rep. Mann will be the chief author of this bill in the House.
The third bill (SF365) works towards that same goal of accountability by creating transparency between insurance companies and their customers. It mandates that insurance providers disclose the brand of insulin and type of equipment provided under a healthcare plan. “Insulin equipment is expensive too. Minnesotans need to know their needles, pumps and patches are covered just as much as their insulin,” explained Sen. Little.
Sen. Abeler, one of the bill’s co-authors added, “This bill also stops insurance companies from being able to pull coverage on a type of insulin during someone’s contract. This will make sure people get exactly what they paid for.” Rep. Masin will be the chief House author.
The final bill (SF364) creates a long-term plan for keeping insulin prices low for customers, and allows the Minnesota Commissioner of Health to hold insulin manufacturers accountable for their prices by imposing reimbursement charges. The Commissioner will collect and analyze data submitted from manufacturers, pharmacies and insurance providers to determine a reasonable price for insulin. Rep. Halverson will be chief author of this bill in the House.
“The data shows that when one of the companies increases their price, the rest will follow,” Sen. Little noted. “Obviously, this only makes things worse for the people who need insulin. With this bill the Commissioner can monitor prices. All the data would be published publicly too, so anyone can look into price hikes. It’s part of our push for transparency and honesty in pricing.”
“The truth is, we shouldn’t have to take these measures,” said Sen. Little, “but the market has failed and left people’s lives at risk.”
Sen. Klein, a doctor at Hennepin Healthcare, explained how he’s seen these issues first-hand, “The pricing problem leaves patients in a dangerous, vulnerable place,” he noted “Patients who have run out of insulin regularly see me in the hospital, often in extremis. We help them out, but at a high cost to their lifelong health and to the system.”
“Thankfully, these bills are getting a lot of bipartisan support,” Sen. Little noted “All four of the bills we’re proposing have authors from both sides of the aisle.” Sen. Scott Jensen, a republican and medical doctor, co-authored SF 365 along with Senators Klein and Franzen, both democrats. “This is an issue of moral values, and many Minnesotans agree that it shouldn’t be a partisan debate,” added Sen. Franzen.
“This is an entirely preventable crisis,” concluded Sen. Little. “There is absolutely no reason anyone in Minnesota should die because they can’t afford their insulin.”