Insulin safety net program established

Diabetics will be able to get affordable insulin on both an emergency and long-term basis as part of the Alec Smith Insulin Affordability Act.

Under a new law, most manufacturers of insulin will be required to establish procedures to make insulin available to eligible individuals who are in urgent need of insulin or need access to an affordable insulin supply. This must be done by July 1, 2020.

Beginning on that date, diabetics with less than a seven-day supply of insulin readily available and who need the drug “in order to avoid the likelihood of suffering significant health consequences” will pay no more than $35 to get a 30-day supply from a pharmacy.

To get insulin, people would need to present a filled out an application created by MNsure and attest to eligibility requirements. A requestor must also have a valid prescription and show proof of Minnesota residency with an identification card, driver's license or permit.

Upon receipt of the application, a pharmacist is to dispense a 30-day supply of prescribed insulin and notify the practitioner who issued the prescription no later than 72 hours after the insulin is dispensed. Insulin manufacturers will either reimburse pharmacies for the cost of emergency insulin or replace the insulin provided to patients.

Each manufacturer will also be required to create a patient assistance — or continuing safety net — program available to an individual who:

• is a Minnesota resident with a valid Minnesota identification card, driver’s license, or permit;

• has a family income equal to or less than 400 percent of the federal poverty guidelines;

• is not be enrolled in Medical Assistance or MinnesotaCare;

• is ineligible to receive health care through a federally funded program or receive drug benefits through the Department of Veterans Affairs; and

• is not enrolled in drug coverage through an individual group plan that limits cost-sharing (including copayments, deductibles, or coinsurance) for a 30-day supply of insulin to $75 or less, regardless of the type or amount of insulin.

Someone enrolled in Medicare Part D is eligible for an assistance program if they’ve spent at least $1,000 on prescription drugs in the current calendar year.

Under the program, someone can receive up to a 90-day supply of insulin from manufacturers. Insulin is provided on an ongoing basis for the 12-month eligibility period and eligibility for the program may be renewed. The safety net provision expires Dec. 31, 2024, unless the Legislature determines it should continue.

Per the law, “The pharmacy may collect a co-payment from the individual to cover the pharmacy’s costs for processing and dispensing in an amount not to exceed $50 for each 90-day supply if the insulin is sent to the pharmacy … a manufacturer may send the insulin as ordered directly to the individual if the manufacturer provides a mail order service option.”

Manufacturers with annual gross revenue of $2 million or less from insulin sales in Minnesota will be permitted to request a waiver to be exempt. An insulin product is exempt from the law if the wholesale acquisition cost is $8 or less per milliliter or applicable National Council for Prescription Drug Plan billing unit, for the entire assessment time period, adjusted annually by the consumer price index.

The law allows the Board of Pharmacy to assess administrative penalties for each month of noncompliance. Manufacturers that fail to comply with the law would face up to $3.6 million in fines the first year; $7.2 million the second.

Annual program reports are due to the Board of Pharmacy and the Legislature.

MNsure is to conduct a public awareness campaign related to the insulin safety net program. The law appropriates $250,000 from the Health Care Access Fund in fiscal year 2020 for the campaign.

Among the other $509,000 in 2020-21 biennial funding, the law appropriates $76,000 in fiscal year 2021 from the fund for the Board of Pharmacy to implement the insulin safety net program.

Nicole Smith-Holt and James Holt pushed the Alec Smith Insulin Affordability Act after their son, Alec, died in 2017 at age 26 after rationing his insulin to get to payday. Smith had $1,000 in his bank account, but needed $1,300 to get insulin. His story put skyrocketing insulin costs in the national spotlight.

Most provisions of the act are effective April 16, 2020, with three information provisions to take effect July 1, 2020.

Rep. Michael Howard (DFL-Richfield) and Sen. Scott Jensen (R-Chaska) are the sponsors.

HF3100*/SF3164/CH73

HF3100* / SF3164 / CH73