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Insulin insulation: Comparing insulin safety-net programs in Missouri and Minnesota

  • Writer: Ross Baumgardner
    Ross Baumgardner
  • Jul 26
  • 6 min read

Updated: Jul 31

Rationing of insulin due to cost is a problem in America (Fang & Selvin, 2023; Right Care Alliance, 2025). Between 2012 and 2016, the cost of insulin for victims of Type 1 diabetes doubled (Advisory Board, 2023). In response, lawmakers at state and federal levels embarked on legislative efforts to contain and subsidize the costs of insulin (see e.g., Hawley, 2023). While some policies have been effective, others see both constitutional and economic hurdles. In 2020, Minnesota’s legislature successfully passed the Insulin Safety Net Program. Minn. Stat. § 151.74. This program has met with constitutional challenges under the Takings Clause of the 5th Amendment. In 2025, Missouri state legislature considered H.B. 1195, which, like Minnesota’s law, was aimed at controlling insulin costs; it was referred to rules committee where it remains unenacted. This post will provide a brief background on insulin and Type 1 diabetes mellitus, will examine the challenges to Minnesota’s law, and then summarize the Missouri bill for potential failures which can be gathered by the example provided in Minnesota.


Note: this is an opinion work and nothing in this post should be construed as legal counsel or an attempt to influence legislation. For advice specific to your situation, please consult a qualified attorney or appropriate legal professional.


Background

Type 1 diabetes is an autoimmune disease in which a body’s immune system destroys irreproducible insulin-producing cells in the pancreas, leaving cell glucose absorption untriggered. Prior to the discovery of injectable insulin, therapies for Type 1 diabetes were largely ineffective and untreated Type 1 diabetes is fatal. Fourteen-year-old Leonard Thompson was the first patient to receive an insulin injection, developed by Frederick Banting, a young orthopedic surgeon, and his student Charles Best, in 1922. (Tattersall, 2017, p. 12). Practically overnight, patients plagued by a condition called diabetic ketoacidosis, which results from a body’s inability to process the accumulating glucose, were able to see blood glucose levels return to normal ranges. Banting, Best, and another researcher were awarded U.S. patents in 1923, which they sold to the University of Toronto for $1 each – Banting is quoted as having stated, “Insulin does not belong to me, it belongs to the world” (Diabetes UK, n.d.). While insulin in those years was extracted from animals, insulin today is produced synthetically. Eli Lilly, Novo Nordisk, and Sanofi are the primary producers of insulin products.


Missouri H.B. 1195

In 2025, Representative Pouche of Missouri, R-District 13, introduced H.B. 1195, which originally capped thirty-day supplies of insulin and epinephrine injections. H.B. 1195, 103rd Gen. Assemb. (Mo. 2025). The bill was originally recommended “Do-Pass” with House Committee Substitution which included emergency dispensing guidelines and modifications to five state statutes that would allow for this dispensing. While there was no opposition voiced in hearings, the legislative materials suggest that “Others testifying on the bill say that many members of the Missouri Insurance Coalition are offering this type of program or plan.” HCS HB 1195 - - ACCESS TO MEDICAL PRODUCTS, 103rd Gen. Assemb. (Mo. 2025)(based on testimony of Hampton Williams). The bill was referred to the rules committee where it will eventually expire; it (and its predecessors in 2024 and 2023) will not become enacted in 2025.

There are many unknowns with bills that do not get enacted; politics and lobbying behind the scenes often play a big role in whether a bill is voted for, against, or referred to a committee where it is left to expire. Here, legislative materials do not document such influences on the life of this bill. While this is one example of a well-intentioned bill that did not become enacted, the challenges that often face these types of bills are better defined by looking at examples in other states. Minnesota enacted a bill more expansive than Missouri’s, which met with constitutional challenges.


Minnesota’s Insulin Safety Net Program

The Alec Smith Insulin Affordability Act was enacted with the aid of public support following the tragic death of 26-year-old Alec Smith, a Minnesotan who was unable to afford $1,300 cost of insulin and whose attempt to ration his insulin supplies proved fatal (Minnesota Legislature, 2021). This Act required manufacturers of insulin products to provide free insulin to Minnesotans who met certain criteria. In response, Pharmaceutical Research and Manufacturers of America (PhRMA) sued the Minnesota Board of Pharmacy, alleging the Act is unconstitutional under the Takings Clause of the Fifth Amendment, which provides that “private property shall not be taken for public use without just compensation.” U.S. Const. amend. V. The 8th Circuit Court reversed the district court’s dismissal for lack of standing and held that PhRMA had standing to bring this claim in Pharn. Rsch. & Mfrs. Of Am. V. Williams (2023) and remanded for further proceedings.

Before these allegations could be tried, the Minnesota legislature amended the Act to allow manufacturers to seek compensation for insulin they supply under the Act and requires insulin manufacturers to pay a $100,000 annual registration fee, beginning on November 1, 2024. Minn. Stat. § 151.74. This foreclosed on the claim that the insulin products themselves were the taken property challenged under the Fifth Amendment. Accordingly, PhRMA amended its complaint to allege that the $100,000 registration fee is an unconstitutional taking. On June 3, 2025, the district court denied the motion to dismiss and the case remains ongoing. Pharm. Rsch. & Mfrs. Of Am. V. Chakolis (2025).

This shows that in 8th Circuit (which includes both Minnesota and Missouri), courts are willing to consider whether a state law, which requires the provision of free insulin products or which requires a registration fee to offset those costs, is unconstitutional on Fifth Amendment grounds. The Minnesota bill is different from Missouri’s in that it initially required manufacturers to provide insulin products to qualified recipients and then was amended to include a registration fee, rather than a free provision requirement. By contrast, Missouri’s bill was regulatory in the sense that it created a cap on payments and granted dispensary authority to pharmacists for emergency situations and under certain conditions.

There are fair reasons for manufacturers to oppose bills resembling either Minnesota’s or Missouri’s; profit margins decrease, potentials for abuse, and such requirements are specifically targeted at insulin products and may not be viewed as fairly applicable to other market sectors. However, there are broader economic impacts that are not considered by the legislative histories. If a manufacturer is obligated by law to provide supplies, pay a registration fee, or an insurer is required to provide medicine with capped payments from its insured, those businesses will likely pass along those costs by cutting employee salaries or benefits, decreasing the quality of their product, or increasing the price. In other words, costs are redistributed, not eliminated.

This problem lays bare the fundamental dilemma – whether legislation that regulates is fundamentally superior to legislation that incentivizes access to affordable insulin. Either state might be better served if it focused on incentive-based approaches. Additionally, in the longer term, if people had more money in their pockets, i.e. the state and federal taxes decreased overall, those with medical needs would have more cash on-hand to make those purchases and those without medical needs would have more expendable cash to donate to nonprofit and charitable causes, like Insulin For Life USA or Project Insulin.

A final note is that public health policy makers should refrain from assuming that “big pharma” is always the enemy. Such assumptions create divides when manufacturers sometimes can be allies. For example, with regard to insulin affordability, Novo Nordisk provides a helpline for individuals who are “at risk of rationing [] insulin and have an immediate need” (Novo Nordisk,  2023). Plus, if a manufacturer decides it is not worth their effort or finds the production of a medication to be a losing enterprise, they may discontinue producing that medication. It appears that government sometimes does more harm than good when social emotions run high.


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