North Dakota Moves to Shield Diabetes Patients From Insulin Price Shock
For the Kritzbergers, insulin is not an abstract policy debate. It is the difference between stability and a medical emergency.
Ang Kritzberger and her daughter Nina have spent years organizing their lives around Type 1 diabetes, with insulin, pump supplies, glucose monitoring equipment, and emergency backups always in motion. Nina was diagnosed at age 7, and the family’s routines shifted immediately into round-the-clock vigilance. Even with insurance, the household has been paying at least $8,000 a year for drugs, supplies, and medical appointments.
North Dakota lawmakers responded to that kind of pressure by capping what many patients pay for insulin at $25 a month. The law places the burden of high drug prices back where state leaders say it belongs: on a system that had made a century-old medicine unaffordable for too many families.
A missed dose can become a crisis in hours, not weeks. For patients with Type 1 diabetes, insulin is not optional maintenance therapy; it is survival medicine.
A Bipartisan Break From the Usual Healthcare Fight
The bill’s political path says as much about the scale of the problem as the final vote does. In a state where Republicans dominate the legislature, the insulin cap still won overwhelming bipartisan support after years of public frustration with drug pricing and insurance design. State Sen. Sean Cleary, a Republican, said lawmakers from both parties converged on the same basic conclusion: the market was not working for families who depend on insulin every day.
The measure limits what patients pay out of pocket each month, even when a high-deductible health plan would otherwise leave them exposed to steep early-year costs for other care. That structure matters because many families do not experience health spending as a single bill. They experience it as a cascade — insulin at the pharmacy, pump supplies, test kits, visits, and the constant threat that one expense will crowd out another.
North Dakota now joins 28 other states with similar insulin copay protections. Colorado became the first in 2019, and the federal government later capped insulin at $35 a month for Medicare enrollees in 2022. Private insurance, however, remains a patchwork. Federal efforts to extend a cap beyond Medicare did not survive congressional opposition.
What High Insulin Costs Do to Real Families
The financial burden is not theoretical. It changes behavior at the bedside and at home.
Across the country, soaring insulin prices pushed many people with diabetes to ration doses, skip refills, or delay care. Some died after running short of a drug they could not safely go without. The average yearly out-of-pocket cost for people with private insurance reached $470 in 2018, then fell to $220 in 2025 as manufacturers faced public backlash and some prices moderated. Even so, those averages can obscure the stress felt by individual families, especially when a child depends on multiple devices and backup supplies.
Nina Kritzberger described a life built around contingencies: a spare pump, a spare Dexcom, a testing kit, glucose, Gatorade, and the vigilance to catch a low blood sugar event before it becomes dangerous. Her description was blunt because the physiology is blunt. Without insulin, the body cannot regulate glucose, cells cannot access energy properly, and the immune system’s misguided attack on pancreatic beta cells continues unchecked. The result is rapid metabolic decompensation, hospitalization, and potentially death.
For households already carrying debt from farming and everyday expenses, insulin prices can intensify a chronic disease into a financial one.
Insurers Warned About Premiums; Families Pointed to Preventable Harm
Insurers and the state chamber of commerce argued that a copay cap for one drug would shift costs onto everyone else through higher premiums. Blue Cross Blue Shield of North Dakota made that case directly. The concern is familiar in health policy: when one benefit is mandated, payers often warn that the expense will be redistributed across the broader pool.
Families and advocates countered with a different kind of evidence — the kind that comes from observing whether a policy actually changes behavior without destabilizing the system. Supporters pointed lawmakers to an earlier state employee insulin cap that appeared to have little effect on premiums. That example helped weaken the argument that the state could not intervene without causing broad harm.
Janelle Moos, who lobbied for AARP, said many Republicans framed the issue as a question of government overreach. Yet the pressure from patients, caregivers, and diabetes educators changed the tenor of the debate. The families who testified in Bismarck were not speaking in abstractions. They were describing dosing decisions, travel burdens, and the fear of running out.
Why a Price Cap Matters in a Disease That Never Pauses
Diabetes management is unforgiving because the disease does not wait for insurance calendars, annual deductibles, or legislative compromise. A cap on monthly insulin spending does not solve every cost problem, but it does remove one of the most dangerous financial barriers in chronic disease care.
State Rep. Carrie McLeod, a Republican and diabetes educator, argued that the system had drifted too far toward financial engineering and away from patient need. Her perspective reflects a broader shift: even in conservative states, lawmakers have begun treating insulin access as a public protection issue rather than a niche health policy dispute. The century-old drug is too essential, and the consequences of underuse too severe, for many legislators to defend the status quo.
The cap also reaches beyond one family’s checkbook. It gives patients room to stay adherent, keep pharmacy visits predictable, and avoid the dangerous arithmetic of deciding whether to stretch a vial or skip a refill. In diabetes care, adherence is not simply about compliance; it is a way to prevent acute metabolic collapse and longer-term vascular injury.
North Dakota’s law does not end the insurance industry’s cost arguments, and it does not erase the broader problem of high healthcare spending. It does, however, mark a concrete political judgment: for insulin-dependent patients, unaffordable access has become intolerable. The remaining question is how many other states will follow, and whether private insurance markets will continue to resist caps even as public pressure keeps building.