In June 2019, Lija Greenseid handed Minnesota Gov. Tim Walz an empty vial of insulin that her 13-year-old daughter had painted gold.
Greenseid鈥檚 daughter has Type 1 diabetes, which means she requires daily injections of manufactured insulin to stay alive. The price of a single vial of insulin between 1996 and 2018, and the gold vial was a reminder, Greenseid said, that this lifesaving pharmaceutical shouldn鈥檛 be as expensive as precious metal.
鈥淲hat I heard is that that gold vial remained on his desk at the governor’s office, and he brought it up throughout that summer and fall when he was trying to talk to legislators to get them moving,鈥 Greenseid said.
Ten months later, in April 2020, Walz signed the . The law was named after the 26-year-old Minnesotan whose from rationing insulin for the patient the high cost of insulin in the U.S. into a national political priority.
Now it鈥檚 an issue in the presidential campaign. Both former President Donald Trump and Vice President Kamala Harris and her running mate, Walz, have sought to appeal to the nation鈥檚 8.4 million insulin users and their families by touting policies that make insulin cheaper for some patients.
But advocates for diabetes patients fret that neither presidential candidate would go as far as Walz鈥檚 Minnesota law, which helps patients even if they are uninsured, despite the law being under legal attack by the drug industry.
The landscape on insulin pricing has already changed significantly in the past five years. One month after Walz signed the Minnesota law, the Trump administration announced a voluntary program for Medicare prescription drug plans to cap copayments for some insulin products at $35. Two years later, President Joe Biden signed a law to cap copayments for insulin at $35 a month.
Now, amid the current presidential campaign, Harris has proposed extending that $35 cap on insulin copayments to Americans with commercial health insurance.
The Trump campaign鈥檚 national press secretary, Karoline Leavitt, touted his efforts on prescription drug prices when he was in the White House, including approval of a pathway for prescription drugs to be imported from Canada as well as the voluntary $35 insulin Medicare copayment cap. But she did not offer new insulin-specific initiatives for his possible second stint as president.
鈥淧resident Trump will finish what he started in his first term,鈥 Leavitt wrote in a statement.
Copayment caps, which , are popular policies because they provide an immediate financial benefit that many patients see at the pharmacy, according to University of Southern California economist . They鈥檙e also relatively easy to implement.
But copayment caps don鈥檛 address the high list price of insulin itself, so uninsured patients don鈥檛 benefit from such rules. About 1 in 12 Americans lacked health insurance last year.
That鈥檚 what makes Minnesota鈥檚 insulin safety net different. The system has two parts: an that allows individuals to get a one-time, 30-day supply of insulin for $35, and a that provides insulin to eligible patients for a year at no more than $50 for a 90-day supply.
By contrast, list prices for a 30-day supply of insulin can easily top $215, depending on the insulin.
The bill that created Minnesota鈥檚 program was bipartisan out of necessity. Republicans controlled the state Senate at the time, while the Minnesota Democratic-Farmer-Labor Party held the House and governor鈥檚 office.
Nicole Smith-Holt, whose son the bill was named after, as it finally passed the state legislature in 2020.
鈥淚 was happy. I was relieved,鈥 Smith-Holt said. 鈥淚 was sad that it took Alec dying to get to the point where people could walk into the pharmacy and pick up their prescription for an affordable price.鈥
But because Minnesota鈥檚 program requires insulin manufacturers to provide the insulin, it has prompted a backlash from manufacturers. Pharmaceutical industry lobbying group PhRMA filed a , arguing it violates the 鈥溾 of the U.S. Constitution, which says private property can鈥檛 be taken for public use 鈥渨ithout just compensation.鈥
That suit is ongoing, yet the state program is up and running and by the end of 2023 it had been .
PhRMA spokesperson Reid Porter said his group is committed to helping patients afford medicines. Insulin makers voluntarily dropped list prices last year and now offer patient assistance programs for affording the drugs. And the the voluntary Medicare copay cap Trump announced in 2020.
Porter said insulin costs have been driven up by insurance companies and pharmacy benefit managers, also 鈥 the middlemen between insurance plans or employers and drug manufacturers 鈥 when they pocket the discounts from the list price of drugs that they negotiate with manufacturers.
鈥淢innesota’s insulin program does not solve this problem and is unconstitutional,鈥 Porter said. 鈥淭his is not how the system should work, and why it鈥檚 critical that policymakers should prioritize reforming the PBM system, a solution that puts patient health over politics.鈥
In 2021, Sood that found that, despite insulin list prices rising between 2014 and 2018, income received by drugmakers decreased while increasing for intermediaries like PBMs and pharmacies.
In September, the Federal Trade Commission against the nation’s three biggest PBMs, alleging they created a system that inflated insulin prices. The .
, a physician at the University of Pittsburgh, said that regardless of who wins in November he doesn鈥檛 expect existing insulin policies like Medicare鈥檚 to be rolled back, due in part to the advocacy of people like Smith-Holt and Greenseid.
鈥淭hey’ve been really effective at tying high insulin prices with really bad, morally repugnant outcomes,鈥 Luo said.
The key in Minnesota was including real stories, Greenseid said.
鈥淲e had enough real people who reached out and had conversations and helped to show politicians the extent of the problem,鈥 Greenseid said, 鈥渁nd they listened.鈥
