North Dakota Caps Insulin at $25 as Bipartisan Support Grows

Residents of North Dakota who rely on state-regulated health insurance can now cap their monthly out-of-pocket costs for insulin at $25. The measure took effect this year following a vote last year that passed with overwhelming bipartisan support. The law protects patients from high deductibles that previously forced some to pay thousands of dollars before coverage for the drug began.

The state joins 29 other states that have enacted similar pricing limits. Federal data showed that average annual out-of-pocket costs for insulin for people with private insurance were $220 in 2025. That figure represents a decline from $470 in 2018, but advocates argue the cost remains a burden for many families. About one in five of the estimated 40 million Americans with diabetes depends on insulin, a drug in use for a century.

State Sen. Sean Cleary, a Republican, co-sponsored the legislation. He cited a market that was not functioning for patients. "I think there was broad-enough agreement that this market just wasn't functioning for folks," Cleary said. State Rep. Carrie McLeod, a Republican and diabetes educator, noted that the healthcare system had become too focused on financial bottom lines. She said insurance companies had moved away from their original mission of helping people with catastrophic needs.

The bill faced resistance from health insurers and the state chamber of commerce. Blue Cross Blue Shield of North Dakota lobbyist Megan Hruby told lawmakers that passing coverage mandates would make insurance less affordable for everyone. She argued that the price relief for diabetic patients would result in higher premiums for others. Janelle Moos, a lobbyist for AARP, said many Republican lawmakers initially believed government should not play a role in pricing.

Ang Kritzberger, a farmer in Hillsboro, testified at the Capitol in Bismarck alongside her daughter Nina, who has Type 1 diabetes. Ang said the family spends at least $8,000 annually out-of-pocket for drugs, supplies, and appointments despite having insurance. Nina, now 17, described the anxiety of managing her condition. She said a missed dose could cause her body to shut down, requiring a hospital stay.

State Sen. Tim Mathern, a Democrat, led the early push for the cap in a Senate with 42 Republicans and five Democrats. He said he struggled to find supporters initially. The final vote came after lawmakers saw evidence that a similar measure for state employees had little impact on premiums. The new state law applies only to plans regulated by North Dakota, leaving large employer plans under federal jurisdiction.