Minnesota Passes the Alec Smith Insulin Affordability Act

4/17/20
WRITTEN BY: Lala Jackson
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Editor’s Note: If you or a loved one are struggling to pay for insulin, visit our Get Insulin resource page



On April 14, 2020, Minnesota passed
The Alec Smith Insulin Affordability Act, named for a 26-year-old man who passed away in 2017 because he could not afford his insulin after aging off of his parent’s insurance. The bill is one of many state-led insulin pricing bills making their way through state legislation across the US.

The Alec Smith Insulin Affordability Act passed after previous versions had stalled in disagreements between the Democratic state House and Republican state Senate. The final bill creates two tracks of coverage, set to begin in July 2020. Both tracks of coverage only apply to Minnesota state residents who are not covered by MinnesotaCare (Minnesota state Medicaid). 

Track 1: Emergency Insulin Supply

  • Provides an emergency, once-per-year 30-day supply of insulin to those who have less than 7 days of insulin on hand 
  • Pharmacies may charge a maximum $35 copay for a 30-day supply
  • Requires a valid prescription 
  • No income requirement
  • Available to those whose current healthcare coverage status would force them to pay more than $75 out of pocket per month for insulin. This includes those with no insurance or with private insurance, including those with high deductible health plans.
  • Individuals can receive the coverage by filling out an application form that will be made available on the MNsure state website and in pharmacies and clinics that dispense insulin. 

Track 2: Ongoing Insulin Coverage

  • Provides ongoing insulin coverage to those who qualify 
  • Pharmacies may charge a maximum $50 copay for a 90-day supply 
  • Requires a valid prescription 
  • Available to those whose 
    • Income is less than 400% of the federal poverty level (in 2020, this works out to a $104,800 maximum income for a family of four, or a $51,040 maximum income for an individual)
      AND
    • Current healthcare coverage status would force them to pay more than $75 out of pocket per month for insulin. This includes those with no insurance or with private insurance, including those with high deductible health plans.
  • Those on Medicare Part D may qualify if they have spent more than $1000 in the current calendar year for prescription drugs.
  • Individuals can receive coverage by applying directly through the manufacturer Patient Assistance Programs 

The legislation essentially expands existing Patient Assistance Programs from manufacturers for residents of Minnesota, with most of the cost of insulin under the expanded programs covered by the manufacturers. The bill goes further than many existing manufacturer Patient Assistance Programs by covering some of those with health insurance, provided their health insurance out of pocket expense would have been more than $75 for either a 30-day supply (emergency insulin) or 90-day supply (ongoing coverage) of insulin. This is especially important for individuals on high-deductible health plans who may be faced with the full list price of insulin, especially at the beginning of the calendar year. 

To date, nine other states have passed various versions of insulin price cap legislation, seven of which were passed since March. Each of the other nine only apply to residents with private health insurance. Colorado, Illinois, New York, Washington, and West Virginia’s legislation caps out of pocket costs at $100 per month. Virginia caps out of pocket costs at $50 per month, Maine at $35, Utah at $30, and New Mexico at $25. 


Editor’s note: If you are covered by private insurance, you qualify and may be able to find additional cost saving measures by utilizing manufacturer copay cards, with out of pocket costs ranging from $0 – $99. If you do not have insurance, those who take Lilly insulin are eligible for a $35 copay card, and those who take Novo Nordisk or Sanofi insulin are eligible for $99 out of pocket programs. All can be found on our Get Insulin page.


In the United States, insulin assistance programs remain a patchwork, with no clear, singular means of reliable access to insulin at a low out of pocket cost. Eligibility for coverage programs varies dramatically based on insurance coverage (no insurance, private/commercial insurance, or federal insurance like Medicare or Medicaid), income level (with patient assistance programs capped to only cover those who make less than 400% of the federal poverty level), and brand of insulin taken. Because coverage programs are state or manufacturer based, barriers remain for people with insulin-dependent diabetes. 

The Alec Smith Emergency Insulin Bill is a vital step in the right direction, and an important improvement for insulin-dependent Minnesotans. This bill could save the lives of people like Alec who, despite having a job and steady income, did not have access to affordable, consistent health insurance coverage or the insulin required to live.

 

If you or a loved one are struggling to pay for insulin, visit our Get Insulin resource page



Lala Jackson

Lala is a communications strategist who has lived with Type 1 diabetes since 1997. She worked across med-tech, business incubation, library tech, and wellness before landing in the T1D non-profit space in 2016. A bit of a nomad, she grew up primarily bouncing between Hawaii and Washington state and graduated from the University of Miami. You can usually find her reading, preferably on a beach.