North Dakota Insulin Cap: State Enacts $25 Monthly Limit
North Dakota becomes one of 29 states to limit out-of-pocket insulin costs, a move driven by bipartisan frustration with rising prescription drug prices.
By Gavin Wilson ·
The Kritzberger family has farmed in the Red River Valley for more than a century, but for the past decade, their primary financial stress has not been crop yields or livestock losses. It has been the cost of managing Type 1 diabetes for their daughter, Nina, who was diagnosed at age 7. The family now spends at least $8,000 annually out of pocket for drugs, supplies, and medical appointments despite carrying health insurance.
North Dakota lawmakers recently passed legislation capping patient out-of-pocket costs for insulin at $25 per month. The measure limits what patients pay directly for the medication, even if their health plan features a high deductible that would otherwise delay coverage for other medical services. North Dakota is one of 29 states that have enacted similar price caps in response to years of soaring insulin prices.
State Sen. Sean Cleary, a Republican, co-sponsored the bill. He noted that while Republicans typically favor free-market approaches, there was broad agreement that the insulin market was not functioning correctly for patients. Cleary pointed out that many families faced impossible choices between rationing medication or skipping other treatments due to high monthly costs.
The legislative effort was led by State Sen. Tim Mathern, one of only five Democrats in a 42-member Republican-majority Senate. Mathern initially struggled to find allies among his colleagues. However, the bill ultimately passed with overwhelming bipartisan support after patient advocates and families like the Kritzbergers testified at the state Capitol in Bismarck.
Health insurers and the state chamber of commerce opposed the cap, arguing it would raise premiums for all policyholders. Megan Hruby, a lobbyist for Blue Cross Blue Shield of North Dakota, told lawmakers that passing coverage mandates does not make health insurance more affordable. Nevertheless, supporters presented data showing that a similar measure for state employees had little impact on insurance costs, helping to sway skeptical legislators.
The federal context for this state-level action includes a 2022 law signed by President Joe Biden that capped insulin prices at $35 per month for Medicare enrollees. A proposal to extend that cap to people with private insurance failed in Congress due to Republican opposition. Currently, the U.S. Senate is considering a national insulin price cap, with co-sponsors including North Dakota Republican Sen. Kevin Cramer.
Average out-of-pocket costs for people with private insurance have declined from a peak of $470 per year in 2018 to $220 in 2025. Approximately 40 million Americans have diabetes, and about one-fifth of them depend on insulin. The state cap in North Dakota applies only to health plans regulated by the state, leaving plans for larger employers under federal oversight.
