Portugal Colonial - North Dakota Enacts Bipartisan Insulin Price Cap Amid National Push

HILLSBORO, N.D. — The Kritzberger family has cultivated land in the Red River Valley for more than a century. Once raising livestock, they now grow sugar beets, soybeans, and grains. Like many agricultural producers, they work to balance their finances, but for the past decade, they have faced an additional financial burden: their daughter Nina’s Type 1 diabetes.

The condition has placed the family at the center of a national debate over insulin affordability. Ang Kritzberger recalled the early days of her daughter’s diagnosis, noting she slept by Nina’s bedside for the first 60 days and had to prick her finger every two hours around the clock to monitor her health. Even with insurance, the family pays more than $8,000 annually for drugs, supplies, and medical appointments.

Nina Kritzberger, now 17, manages a complex regimen of equipment. She must ensure she has insulin, a spare pump, and a spare Dexcom glucose monitor. She also keeps a testing kit and Gatorade on hand in case her blood sugar drops dangerously low. A missed dose could lead to hospitalization or death as her body begins to shut down.

The Kritzbergers’ experience reflects a broader trend across the United States, where soaring insulin prices have forced many patients to ration medication with potentially fatal consequences. In response, a growing movement has emerged to cap what people with diabetes pay for the drug. This effort has united Democrats and Republicans, tapping into an emerging consensus that government intervention is necessary to protect patients from high drug prices.

North Dakota state Sen. Sean Cleary, a Republican, noted the unusual alignment of political views on this issue. Typically, Republicans favor free-market approaches while Democrats support government intervention, but Cleary said there was broad agreement in North Dakota that the insulin market was not functioning for patients. He co-sponsored legislation last year to cap patient bills at $25 a month.

North Dakota is one of 29 states that have enacted such measures. The cap limits out-of-pocket costs every month for insulin, even for patients with high deductibles who might otherwise pay thousands before their coverage kicks in for other healthcare services like physician visits or hospitalizations.

Patient advocates, including the American Diabetes Association, began pushing for these protections amid stories of patients dying because they could not afford their medicine. About one-fifth of the estimated 40 million Americans with diabetes depend on insulin. Although the drug has been in use for a century, steep price hikes drove out-of-pocket costs to an average of $470 a year in 2018 for people with private health insurance, according to federal data.

Prices have moderated somewhat as drug companies faced public backlash. Average yearly out-of-pocket costs for people with private insurance declined to $220 in 2025. However, for families like the Kritzbergers, a government cap offers protection from future price hikes and relief from the anxiety of managing a serious disease.

The strategy initially gained traction with Democrats. In 2019, Colorado became the first state to enact an insulin copay cap, limiting state-regulated health plans to charging no more than $100 for a 30-day supply. In 2022, President Joe Biden signed legislation capping insulin prices for Medicare enrollees at $35 a month. Biden and congressional Democrats attempted to extend this cap to people with private health insurance, but Republican opposition sank the proposal.

In North Dakota, state Sen. Tim Mathern led the effort to enact an insulin copay cap for state-regulated health plans. As one of only five Democrats in the Senate, which has 42 Republicans, Mathern struggled to find supporters for a long time. He described the isolation of being a Democrat in that chamber, particularly when advocating for progressive public policy.

Health insurers and the state chamber of commerce opposed the measure, arguing that price relief for people with diabetes would lead to higher insurance premiums for everyone else. Megan Hruby, a lobbyist for Blue Cross Blue Shield of North Dakota, told lawmakers that passing coverage mandates does not make health insurance more affordable.

The industry also tapped into lawmakers’ skepticism about regulation. Janelle Moos, a state lobbyist for AARP, which supported the insulin bill, said she was frequently told by GOP lawmakers that it was not the role of government to intervene. "In a state like ours, we hear that all the time," Moos said.

Despite these hurdles, Ang and Nina Kritzberger joined other families who drove hours across the state to testify at the Capitol in Bismarck. Ang Kritzberger recalled the intimidation of facing six lobbyists testifying against her. However, supporters of the bill demonstrated that a similar measure limiting out-of-pocket costs for state employees with diabetes had little impact on insurance premiums.

It also became clear that many lawmakers, including Republicans, had grown frustrated with drugmakers and health insurers. Sen. Cleary questioned why people were paying hundreds of dollars a month for a drug commercially available for decades, citing the broken market and the impossible decisions families faced regarding rationing medication.

State Rep. Carrie McLeod, a Republican and diabetes educator, said the healthcare system had become too focused on the bottom line. She noted that while insurance companies originally aimed to help people with catastrophic needs, things had gotten out of control. When the insulin bill came up for a vote last year, it passed with overwhelming bipartisan support.

The cap will not make healthcare affordable for everyone. States can regulate only some health plans; health insurance provided by larger employers is typically regulated by the federal government. Nevertheless, polls suggest that government regulation of healthcare prices is drawing Americans together. A KFF survey earlier this year found that about seven in 10 U.S. adults, including 68% of Republicans and 77% of Democrats, said there is not enough government regulation to limit prescription drug prices.

Congress is now considering a national cap on insulin prices. Among the bipartisan list of co-sponsors is Sen. Kevin Cramer, a North Dakota Republican. Back on her farm, Ang Kritzberger said the debate showed that North Dakotans are connected and capable of finding common ground, recalling how neighbors recently helped a farmer with brain cancer harvest his sugar beets.

P.L.Madureira--PC