Many MindedNorth Dakota joins 29 states limiting what patients pay for insulin
North Dakota has capped patients' out-of-pocket insulin costs at $25 a month, becoming one of 29 states with such limits. Republican Sen. Sean Cleary co-sponsored the bill last year alongside Democratic Sen. Tim Mathern, who led the effort. Mathern is one of only five Democrats in a Senate with 42 Republicans, and the bill still passed with overwhelming bipartisan support. The cap applies even to patients with high deductibles.
The need is concrete. About a fifth of the estimated 40 million Americans with diabetes depend on insulin. One North Dakota family, Ang Kritzberger's, pays at least $8,000 a year out-of-pocket for their daughter Nina, now 17, who has had Type 1 diabetes since age 7, despite having insurance. Colorado was first to act, in 2019, with a $100 cap per 30-day supply. Federal data show average yearly out-of-pocket insulin spending for the privately insured rose to $470 in 2018 and fell to $220 in 2025.
Why it matters: a hard ceiling turns a variable, deductible-driven cost into a predictable small one for a drug people cannot go without. The politics also look durable. Blue Cross Blue Shield of North Dakota and the state chamber of commerce opposed the bill, arguing it would raise premiums for others, but supporters pointed to a similar cap for state employees that had little effect on premiums. A KFF survey this year found 68% of Republicans and 77% of Democrats say there is too little government regulation limiting drug prices.
Caveats: state caps cover only state-regulated plans, not federally regulated ones such as those of larger employers. The premium dispute was contested rather than settled, and the cap will not make healthcare broadly affordable. Watch Congress, where a national insulin cap co-sponsored by North Dakota Republican Sen. Kevin Cramer is under consideration. A 2022 effort to extend Medicare's $35 cap to private insurance was defeated.
Source: KFF Health News