North Dakota’s Insulin Cap Reflects Bipartisan Frustration With Drug Costs

North Dakota’s decision to limit patients’ insulin costs to $25 a month brought together lawmakers from both parties in a state where Republicans overwhelmingly control the Senate. Approved in 2025, the legislation made North Dakota one of 29 states with such protections, reflecting frustration with a healthcare market that has left some patients rationing essential medicine.

For Ang Kritzberger and her daughter Nina, the debate reached their family’s farm near Hillsboro, where they grow sugar beets, soybeans and grains. Nina, now 17, was diagnosed with Type 1 diabetes at age 7. Despite having insurance, the family pays at least $8,000 annually out of pocket for medications, supplies and medical appointments while also managing substantial farm debt.

Nina’s daily preparations include insulin, backup devices, testing equipment and supplies to treat low blood sugar. Missing insulin could send her to the hospital. For her family, a cap offers some financial certainty alongside the demands of managing a serious disease. Ang and Nina joined other families who traveled hours to testify at the state Capitol in Bismarck.

About one-fifth of the estimated 40 million Americans with diabetes rely on insulin. Years of price increases pushed some patients’ bills into the hundreds or thousands of dollars, and rationing sometimes had fatal consequences. Federal data show that average annual out-of-pocket insulin spending among privately insured patients reached $470 in 2018. After public pressure on drugmakers and moderating prices, that average fell to $220 in 2025.

Democrats initially drove the push for caps. Colorado adopted the first state measure in 2019, limiting charges under state-regulated health plans to $100 for a 30-day insulin supply. Legislation signed by President Joe Biden in 2022 established a $35 monthly cap for Medicare enrollees. A proposal to extend that protection to people with private insurance failed because of Republican opposition.

In North Dakota, Democratic state Sen. Tim Mathern initially struggled to build support in a chamber with five Democrats and 42 Republicans. Insurers and the state chamber of commerce argued that reducing costs for patients with diabetes would raise premiums for other policyholders. Supporters countered with evidence that a similar limit for state employees with diabetes had little effect on premiums.

Republican state Sen. Sean Cleary, a co-sponsor, said lawmakers increasingly agreed that the insulin market was failing families. Republican state Rep. Carrie McLeod, a diabetes educator, also criticized the healthcare system’s emphasis on financial returns. The measure ultimately passed with overwhelming bipartisan backing, overcoming resistance to government intervention.

The North Dakota cap limits monthly insulin payments even for covered patients whose high deductibles require substantial spending before insurance pays for other care. Its reach is limited, however, because states oversee only certain health plans. Coverage offered by larger employers generally falls under federal regulation, leaving state legislation unable to provide universal protection.

The broader debate continues in Congress, which is considering a national insulin cap with bipartisan co-sponsors including North Dakota Republican Sen. Kevin Cramer. A KFF survey earlier in 2026 found that roughly seven in 10 U.S. adults wanted more government regulation of prescription drug prices, including 68% of Republicans and 77% of Democrats.