North Dakota has enacted legislation capping patient out-of-pocket costs for insulin at $25 per month, placing the state among 29 that have implemented similar measures. The initiative gained traction across the country as both Democrats and Republicans united around the goal of protecting patients from escalating drug prices, reversing the traditional partisan divide on government intervention in markets.
The push for price caps emerged from widespread concerns about insulin affordability. An estimated one-fifth of the nation’s 40 million Americans with diabetes depend on insulin. Average yearly out-of-pocket costs for people with private insurance reached $470 in 2018 before moderating to $220 in 2025 as pharmaceutical companies faced public criticism. The drug, in use for a century, has nonetheless experienced steep price increases that forced many patients to ration doses, sometimes with fatal consequences.
In North Dakota, a heavily Republican state with 42 GOP senators compared to five Democrats, achieving passage required overcoming significant industry opposition. Health insurers and the state chamber of commerce argued that price relief would increase premiums for all patients. Despite these objections, Republican state Senator Sean Cleary co-sponsored the legislation, citing recognition that “this market just wasn’t functioning for folks.”
The movement began with Colorado, which became the first state to enact such a cap in 2019, limiting copays to $100 for a 30-day supply under state-regulated plans. President Biden subsequently signed federal legislation in 2022 capping insulin costs at $35 monthly for Medicare beneficiaries. Democratic efforts to extend similar protections to people with private insurance faced Republican opposition and did not advance. North Dakota’s passage demonstrated that state-level action could build coalitions across party lines on the issue.
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