Signs of a compromise on insulin aid as Senate passes bill

Advocates for diabetics in Minnesota expressed optimism Thursday as the Republican-led Senate unanimously approved a long-awaited emergency insulin program, even as differences remain to be worked out with House Democrats who passed a separate insulin assistance bill last month.

The 66-0 Senate vote kicks off a critical phase for the development of an aid program as members of the House and Senate begin work to reconcile the two bills, capping nearly a year of negotiations since efforts collapsed at the end of the 2019 session.

"I'm feeling better about it now than I have, really, since the bill was introduced in the House last year," said Nathan Loewy, a type 1 diabetic and one of the advocates calling for lawmakers to address the unaffordability of the critical drug. "That being said, am I sold on it 100% passing through? … Not yet. There's still a lot of steps that it has to go through before we're there."

That wary optimism was echoed by legislators who have been developing the competing measures aimed at preventing more deaths among people who cannot afford insulin.

The Senate bill, sponsored by Sen. Scott Jensen, R-Chaska, moves closer to the latest House version, which passed on a 75-52 vote in late February. It uses pharmacists, like the House proposed, to dispense the emergency insulin instead of requiring patients to see their doctors.

But Jensen's bill pivots away from House Democrats' funding mechanism, which would impose $38 million in fees on drug manufacturers. Jensen, who said he has talked to House members, insulin activists and Democratic Gov. Tim Walz, believes they are increasingly open to the Republicans' idea of having drug manufacturers provide free insulin rather than pay a fee.

"I think the House is saying, 'We understand what you're proposing here is a reasonable way to get this thing funded without having a big fiscal note and potentially ending up in court,' " Jensen said. After the funding mechanism is sorted out, "Then what we have to do is turn our attention to how do we create an ironclad safety net that doesn't allow anybody to fall through the cracks?"

Rep. Mike Howard, sponsor of the House bill, said he has had productive conversations with Jensen but cannot predict what the Senate will do. Howard, DFL-Richfield, said he has questions about the Senate bill's logistics and whether it would use drug manufacturers' existing assistance programs, which he said would be "problematic based on their track record."

"Until we have signed on the dotted line on an agreement on a bill, I don't think anybody around here deserves any praise or pats on the back," Howard said.

A conference committee made up of both House and Senate members will have to work through differences, including what copays should be required of diabetics seeking insulin.

Jensen had said on Wednesday that the provision in his bill to charge diabetics $75 for a 30-day supply of the drug should be lowered. But on the Senate floor Thursday, Jensen said that more stakeholder input is needed. The House bill calls for a $30 copay. Jensen said not all of his fellow Senate Republicans might be as flexible as he is on those points, and an amendment to reduce the copay to $25 failed in the Senate.

Another amendment — which aligned the bill more closely with the House version — succeeded. It increased the penalty on drugmakers who fail to comply with the program from $100,000 a year to $100,000 a month. That would jump to $200,000 a month if a company is noncompliant for six or more months.

The two sides also differ on proposed sunset dates to the program. Diabetes advocates and Senate Democrats oppose the requirement in the Senate bill to sunset insulin aid at the end of 2023.

"Injectable insulin-dependent diabetes is not a disease that ends. You get diagnosed with it, and you die with it. So to say that this problem will no longer exist in three and a half years is simply not true," said Loewy, who suggested that lawmakers review the program in 2023 instead of ending it.

Jensen said that can be addressed in conference committee.

Meanwhile, the industry group PhRMA is raising concerns about the legislative effort on insulin. In a statement Wednesday, the group listed a number of issues with the Senate bill, arguing that many health plans have already capped copays for insulin. They also contended that requiring manufacturers to provide free insulin, as the Senate bill requires, could be unconstitutional.

Sen. Jim Abeler, R-Anoka, disputed the legal concern. It has taken longer than it should to reach a deal on insulin, he said, but the version the Senate approved would not be shut down in the courts.

"This bill needs a lot of buffing and shining, but it works," Abeler said.

Jessie Van Berkel • 651-925-5044