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Health Care · Report · File No. 261113-388

North Dakota Republicans and Democrats cap insulin copays at $25 a month

In a state where Republicans hold 42 of 47 Senate seats, lawmakers from both parties passed a $25 monthly insulin cap. Twenty-nine states now have similar limits, and Congress is weighing a national cap.

By the Kitchen-Table Desk · · 2 min read

Every quote in this story (2) was matched word for word against its source. How we work

My clippings
Kevin Cramer
Kevin Cramer. Photo: US Senate Photography Studio, Public domain

North Dakota has capped what many patients pay for insulin at $25 a month. Republicans and Democrats backed the measure, according to a KFF Health News report published Nov. 13 1. The state is one of 29 that have enacted such limits 1.

The cap covers health plans the state regulates. It applies even when a patient has a high deductible, which can force people to pay thousands of dollars before coverage starts for other care 1. Insulin is the drug that people with diabetes use to control their blood sugar.

On tapeKFF Health News and NPR · Nov 12
KFF Health News and NPR report on Republicans and Democrats in North Dakota working together to limit insulin costs for people with diabetes.Video: KFF Health News and NPR on YouTube, “North Dakota’s Bipartisan Push To Cap Insulin Costs”. It plays from YouTube when you press play.

A bipartisan vote in a Republican state

North Dakota Sen. Sean Cleary, a Republican, co-sponsored the bill. He said the usual party split did not hold this time 1.

But in this case, I think there was broad-enough agreement that this market just wasn’t functioning for folks.
Sean Cleary, state senator, Republican-North Dakota1

Sen. Tim Mathern, a Democrat, led the effort. He is one of five Democrats in a Senate with 42 Republicans, and he said he long struggled to find supporters 1.

Insurers and the state chamber of commerce opposed the bill. They said relief for people with diabetes would mean higher premiums for everyone else 1. Supporters pointed to a similar cap for state employees that had little effect on premiums 1.

The North Dakota Monitor reported in March 2025 that the state Senate passed the bill 39-7, and that no senators spoke against it. A fiscal analysis put the cost at about $834,000 for the 2025-2027 budget cycle 2.

What the cap does and does not do

The cap has limits. States can regulate only some health plans, and insurance from larger employers is typically regulated by the federal government 1. The cap also does not make health care broadly affordable, KFF noted 1.

Insulin prices have eased since their peak. Average yearly out-of-pocket costs for people with private insurance reached $470 in 2018 and fell to $220 in 2025, according to federal data cited by KFF 1. Advocates say a cap protects families from future price hikes 1.

Medicare enrollees already have protection. In 2022, President Joe Biden signed a law capping their insulin at $35 a month. Biden and congressional Democrats wanted to extend that cap to people with private insurance, but Republican opposition sank the idea 1.

What happens next

Congress is now considering a national insulin cap. Republican Sen. Kevin Cramer of North Dakota is among its bipartisan co-sponsors 1.

Public opinion favors action. In a KFF survey earlier this year, about 7 in 10 adults said there is not enough government regulation to limit prescription drug prices. That included 68% of Republicans and 77% of Democrats 1.

That matters because it shows price limits can win votes in a deep-red state. The pattern is that Republicans who once called such rules an overreach joined Democrats after hearing from families. Mathern's own account shows how long that took 1.

The Record

  1. Colorado became the first state to enact an insulin copay cap, limiting state-regulated plans to $100 for a 30-day supply (the year is from the source; the month and day are placeholders) 1.
  2. President Joe Biden signed a law capping insulin for Medicare enrollees at $35 a month (the year is from the source; the month and day are placeholders) 1.
  3. The North Dakota Senate passed the $25 insulin cap bill 39-7 2.
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Sources

  1. KFF Health News, “Fed Up With the Healthcare Industry, This Red State Capped Insulin Prices for Patients” (2026-11-13). kffhealthnews.org/health-industry/insulin-copay-price-caps-d
  2. North Dakota Monitor via Yahoo News, “Insulin caps bill headed to North Dakota governor” (2025-03-25). yahoo.com/news/insulin-caps-bill-headed-north-223141085.html

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