AN ACT to create and enact a new section to chapter 26.1-36 of the North Dakota Century Code, relating to individual and group health insurance coverage of insulin drugs and supplies; and to amend and reenact section 54-52.1-04.18 of the North Dakota Century Code, relating to health insurance benefits coverage of insulin drugs and supplies.
HB 1114 requires most North Dakota health benefit plans to cover insulin drugs and certain insulin-related medical supplies with strict out-of-pocket limits. For a 30-day supply, covered insulin and covered supplies for insulin dosing and administration may not cost the enrollee more than $25 each per pharmacy or distributor, and plans may not use deductibles, copays, coinsurance, or pharmacy benefit manager billing practices to push costs above those caps. The bill defines covered insulin drugs and supplies, including common insulin types, glucose meters and strips, lancets, ketone testing supplies, glucagon, insulin pen needles, and syringes, while excluding insulin pumps, electronic insulin-administering smart pens, and continuous glucose monitors from the capped-cost requirement.
The bill creates a new insurance mandate in chapter 26.1-36 for individual and group health plans and also amends an existing provision in section 54-52.1-04.18 governing public employee health coverage. It requires the Public Employees Retirement System coverage to conform to the same insulin cost-sharing limits, while preserving the ability of plans to maintain lower cost-sharing if they choose. The bill also includes an accommodation for qualified high-deductible health plans so the insulin cap does not interfere with health savings account eligibility until the federal minimum deductible is met, and it expressly excludes Medicare Part D coverage.
HB 1114 appears to have been broadly supported, though not unanimously. It passed the House 59-27 and the Senate 39-7, indicating clear majority support in both chambers. The vote pattern suggests the bill was viewed favorably as a consumer and diabetes affordability measure, but with a meaningful minority opposed.
The main point of contention is the cost mandate on insurers and the extent of required coverage. Opponents likely objected to imposing a fixed $25 cap regardless of insulin type or quantity and to limiting cost-sharing flexibility for health plans and pharmacy benefit managers. Supporters likely emphasized affordability, predictable access to insulin, and relief for people with diabetes who face high recurring prescription costs. The bill’s exclusions for pumps, smart pens, and continuous glucose monitors also suggest a deliberate effort to narrow the mandate to insulin drugs and basic supplies rather than broader diabetes technology.
HB 1114 expands North Dakota insurance law by imposing a statewide insulin cost-sharing cap on individual and group health benefit plans and by aligning public employee health coverage with that mandate. It affects insurers, nonprofit health service corporations, health maintenance organizations, pharmacy benefit managers, pharmacies, medical supply companies, and insured individuals who use insulin or related supplies. The bill also updates the state’s public employee health coverage statute and preserves federal high-deductible health plan/HSA rules and Medicare Part D preemption.
The overall sentiment around HB 1114 was favorable, with strong bipartisan support reflected in passage in both chambers. The vote margins show that most legislators supported the measure as a diabetes affordability and consumer protection bill, while a smaller bloc remained opposed. No committee transcript was provided, so the available record suggests support was stronger than resistance, but not unanimous.
The likely contention centered on whether the state should require insurers to cap insulin-related out-of-pocket costs at $25 per 30-day supply and whether that mandate would increase premiums or reduce plan design flexibility. Critics may have been concerned about the impact on insurers, employers, and pharmacy benefit managers, especially because the cap applies regardless of insulin quantity or type. Supporters likely focused on affordability for people with diabetes and the need to prevent high recurring costs from limiting access to essential medication and supplies.