The North Dakota legislature passed a bipartisan measure last year to limit out-of-pocket insulin costs for patients at $25 per month. The state joined 28 others that have enacted similar price caps to protect residents with diabetes from medication expenses. The law applies to health insurance plans regulated by the state, though it does not cover plans provided by large employers, which fall under federal regulation.
The push for the cap followed years of rising insulin prices that led some patients to ration their medication. Federal data showed that average annual out-of-pocket costs for people with private insurance reached $470 in 2018. While these costs declined to an average of $220 in 2025 due to drug company price adjustments, advocates and families argued that government-mandated caps were necessary to prevent future price spikes and ensure affordability.
Opponents of the measure, including the state chamber of commerce and health insurers like Blue Cross Blue Shield of North Dakota, argued that such mandates would lead to higher insurance premiums for all policyholders. Lobbyist Megan Hruby told lawmakers that coverage mandates do not improve overall health insurance affordability. However, supporters cited data from a similar program for state employees, which they claimed had a minimal impact on premiums, to persuade legislators.
The scale of the issue is reflected in national data, which shows that roughly one-fifth of the estimated 40 million Americans with diabetes rely on insulin. While the specific number of North Dakotans affected was not reported, the national trend towards regulation is significant, with 29 states now having some form of price cap. The change for a resident is a shift from variable monthly costs—which could hit hundreds of dollars—to a fixed $25 maximum at the pharmacy counter, regardless of whether they have met their annual health insurance deductible.
The passage of this law in a Republican-majority state highlights a shift in policy approach toward the healthcare industry. It sets a precedent for bipartisan cooperation on drug pricing regulation. A KFF survey found that 68% of Republicans and 77% of Democrats believe there is currently not enough government regulation of prescription drug prices. Following this state-level action, the U.S. Congress is now considering a national cap on insulin prices, with co-sponsorship from North Dakota Sen. Kevin Cramer (R).