A bill addressing an issue that has produced more finger-pointing than problem solving over the last two sessions got a unanimous vote in the Minnesota Senate Thursday.
The legislation, Senate File 3019, is the latest and perhaps the last version of an emergency insulin bill that has eluded lawmakers for more than a year. Titled the Alec Smith Insulin Affordability Act, the bill sets up a system in which diabetics who can’t afford the hormone can get it at little cost. Smith was the Type 1 diabetic who died in 2017 while trying to ration his insulin after aging off his parent’s health insurance. The bill now moves to a House-Senate conference committee.
Until the bill was unveiled last week by Sen. Scott Jensen, a Chaska Republican and medical doctor, DFLers and Republicans had spent months arguing over how the supplies of insulin should be paid for.
A DFL proposal set high fees on insulin makers, who Democrats blame for the price increases that often make the hormone unaffordable for those without adequate insurance. Republicans favored using state money for setting up and administering a program while requiring the drug companies to provide insulin at no charge.
How it would work
Jensen’s bill uses no state money and relies on the existing patient assistance programs employed by the drug makers: Sanofi, Lilly and Novo Nordisk. Failure to take part in the program would result in fines for the pharmaceutical companies.
The trade group representing pharmaceutical companies, PhRMA, has opposed the plan, calling it a violation of constitutional prohibitions on taking of private property without compensation. But sponsors suggest the companies will go along, finding the Jensen plan preferable to a House bill that imposes $38 million in license fees on the industry to pay for a state-run program.
There remain disagreements over the size of copays that patients would pay and a sunset clause in the bill. But a third area of potential disagreement might have been resolved Thursday. Sen. Matt Little, DFL-Lakeville, successfully amended the bill to increase the fine for no participating in the patient assistance program from $100,000 a year to $100,000 a month. After six months, a company that failed to join the program would see fines jump to $200,000 a month.
Jensen has said he knew the fine amount in his bill was inadequate and supported the amendment. There was near unanimity on Little’s other amendment: to name the law after Alec Smith.
Jensen said the latest bill “had to do with getting a yes from all stakeholders. We’ve worked hard to make sure everyone can get behind this program.”
Jensen said the existing patient assistance programs, funded by drug makers or their company foundations, are not good enough. The bill asks them to expand and improve them.
Little said he did not consider the drug companies to be stakeholders who had to be consulted. Insulin companies have repeatedly raised prices in recent years, so much so that diabetics without insurance pay up to $5,700 a year for something they can’t live without. “When I hear the term stakeholder, there’s only one stakeholder in mind, and that’s the people who need insulin to live,” Little said.
Jensen said he shared Little’s concerns about the behavior of the industry. “I want to send a strong message to manufacturers that we expect you at some point in time to stop this,” Jensen said.
Before it was approved, Sen. Jim Abeler, R-Anoka, said the program has to work. “It needs a little buffing and shining, but it works,” he said.
The House bill that uses large license fees would likely lead to litigation by the industry because of the precedent it would set for other states. “I’m so angry with their lack of morality and humanity for doing this,” Abeler said of the the drug companies. “But frankly speaking, they have a lot of lawyers, they have a lot of friends and they know how to do any number of injunctions.”
While that was happening, another diabetic without money would die, he said, “and I’m not willing to watch that happen.”
Differences remain between Senate, House bills
Rep. Mike Howard, a DFLer from Richfield who has been a leader in the House on the issue, said the Senate vote puts the Legislature in a “good place to negotiate and reach a deal.”
But he also said there are still issues to resolve. “I would also note the Senate passed a version of this bill last year unanimously and we all remember how that turned out,” Howard said. “No one deserves any slaps on the back until Alec’s Bill is signed, sealed and delivered.”
Insulin advocates sounded more optimistic. “This is another huge step forward, but we still have work to do,” said Nicole Smith-Holt, the co-leader of the state chapter of #Insulin4all and Alec Smith’s mother.
Little, who has been working on the issue since he was approached by a constituent in the summer of 2018, was happy with the passage Thursday, but also frustrated. His name was taken off the sponsorship of the final bill, replaced by Republicans.
Senate Minority Leader Susan Kent, DFL-Woodbury, said the DFL bill was merged with a Republican bill and only five names are allowed as sponsors under Senate rules. The two DFL sponsors that remained were Sens. John Marty of Roseville and Melissa Wiklund of Bloomington.
Little said afterward that he thinks it is part of a pattern by Republicans who hold the majority in the Senate to deny him credit for legislation. Little won a GOP district in 2016 and is Republican’s No. 1 target for defeat this year. Bills he has sponsored have never passed and until this session — never been given a hearing. “I think it’s personal, I think it’s political and I think it’s silly,” Little said.
He said Kent asked that he be one of the two DFL names on the insulin bill and was told no. “They came to our caucus asking if the bill could be moved forward in a certain way and it just became clear that the certain way was that I couldn’t be on it,” Little said. “I said if it gets the bill moving forward it’s okay.”
Still, he was optimistic about the bill. It was Little who convened the first round table discussion of the issue in late 2018 that included advocates and legislators wanting to work on affordable insulin.
“There’s more support in the Senate Republican caucus than there was last year,” Little said. “The debate is about what the co-pay is, how long supply is. That’s an easier debate than whether we should be doing this at all, which is the debate we had last year.”