The Government and Veterans Affairs Committee voted 13-0 to give House Bill 1144 a do-pass recommendation as amended and referred the bill to the Appropriations Committee.

Why it matters: HB 1144 would continue a pilot program that affects access to insulin and insulin supplies. Committee members and the bill sponsor described the measure as life-saving for people with type 1 diabetes and discussed projected costs, industry structure and federal analyses during the committee hearing.

Representative Lissa McLeod, the bill sponsor, explained the amendment before the committee vote. She said the changes are “just very little wording” to align the bill with the insurance commissioner’s terminology and with pharmacy-industry concerns: “the insurance commissioner in that department prefers that we use health benefit plan in the language because that's what they use.” McLeod also summarized federal and actuarial material she handed out to members, citing a Federal Trade Commission press release and a Novarest actuarial report on state costs.

McLeod and others described the market structure that they said drives higher insulin prices. “Insulin used to be $21 a vial, and now we're looking at a 1,200% increase because of the PBMs,” McLeod said, adding that Novarest estimated roughly 57,805 people in the state have diabetes and that 5 to 10 percent of them have type 1 diabetes. The report cited in committee estimated a cost increase of 0.05 to 0.20 percent that would translate to about $0.30 to $1.00 per member per month in projected costs, according to McLeod.

Chairman Schauer, presiding, cautioned members that the pilot program carries political and legislative risk if it moves beyond the pilot: “My concern is the pilot program will go away for North Dakota first,” he said, noting the bill could face opposition from major carriers and chambers as it moves to the floor.

The committee approved the amendment, then approved the bill as amended. The motion to pass as amended was moved by Representative McLeod and seconded from the floor; the roll call recorded 13 votes in favor and none opposed. The committee referred HB 1144 to Appropriations for further fiscal review and potential amendment on the floor.

Next steps: HB 1144 now goes to the House Appropriations Committee. Committee members noted opposition from some large carriers may surface in subsequent committee or floor debate.