Senate insulin plan scrutinized; House proposal to come this week

Senate Republicans’ plan to provide free insulin to some Minnesotans faced its first public scrutiny Monday, with diabetic advocates and Democrats saying it doesn’t do enough to prevent insulin rationing and deaths.

The GOP proposal, unveiled late last week, forces drug companies to provide a year’s worth of insulin to diabetics who meet income limits and other requirements. Critics consider it too cumbersome, a burden on doctors, and unhelpful to diabetics who run out of the life-saving drug.

“Some of you were victims of the ferocity that us mama bears unleash when we feel someone isn’t doing enough to protect our kids,” Lija Greenseid of St. Paul, whose daughter has type 1 diabetes, said at a Senate committee hearing. “What you should know is, while we’ll show our claws if we don’t think you’re with us, we’re also quick to embrace with bear hugs those that join us in this fight.”

Senate Republicans’ hearing came three days before House Democrats are scheduled to roll out their own proposal. The dueling plans are being released amid the backdrop of two deaths in Minnesota since 2017 after diabetics rationed their insulin, and have rekindled the possibility of a special session to address the issue this fall.

Democrats favor allowing diabetics who run out of insulin to get a short-term supply from pharmacists through a program funded by a fee on drug companies.

GOP senators argued Monday that their own proposal would cover the vast majority of diabetics, preventing them from requiring emergency insulin.

“If we can make it affordable before that patient is in crisis, it seems to me that’s a better approach than waiting until that patient is in crisis,” said state Sen. Eric Pratt, R-Prior Lake. Pratt is the lead author of the GOP’s proposal.

People who make up to four times the federal poverty level – nearly $50,000 for an individual and more than $100,000 for a family of four, Pratt said – will qualify for free insulin under the plan.

Eighteen percent of claims to the state’s reinsurance program – which buys down the cost of insurance companies to cover Minnesotans that are most expensive to insure – are for insulin supplies, said state Sen. Michelle Benson, the Republican who chairs the Senate Health committee.

But affordability isn’t the only issue – emergency access is also a concern, Democrats and some Republicans said.

“Please don’t lose sight of the emergency piece. We need to incorporate that into this bill,” said state Sen. Scott Jensen, R-Chaska. Jensen, one of a handful of medical doctors in the state Legislature, read a message he said he got from a patient Friday night about the high cost of insulin.

Jensen and other lawmakers raised concerns that under Pratt’s bill, drug companies would send insulin to doctors’ offices instead of pharmacies, which are typically open for longer hours. Most doctors aren’t set up to dispense large quantities of drugs, they said.

Critics also said the process of enrolling with the state, meeting with a doctor, and receiving a shipment of insulin would be lengthy.

“The timeframe seems too long. Lives can be lost during that waiting period,” said Nicole Smith-Holt, whose son Alec died in 2017 after rationing his expensive supply of insulin.

The insulin debate in Minnesota is a small part of the national debate over the high cost of health care. It’s a key topic in the 2020 presidential race.

Minnesota lawmakers failed in the final hours of the 2019 legislative session to pass an emergency insulin access program named after Smith-Holt’s son. In recent months, four health insurers have capped the cost of insulin co-pays at $0 or $25.

But Minnesotans with little or no health insurance still need help, lawmakers from both parties acknowledge.