ST. PAUL — Democrats in the Minnesota House of Representatives on Thursday, Sept. 26, put forward changes to a plan they said would help diabetics access insulin in situations of emergency.

The move tees up a potential compromise between Democrats and Republicans, who've put forth different plans to make insulin more readily available to Minnesotans who can't afford it. Both would require drug manufacturers to foot the bill for state programs that would help low-income people access insulin.

That was a key sticking point as lawmakers weighed the proposal earlier this year. House Democrats said the drug companies should be held accountable for putting the drug out of reach for many, while Republicans said the state should foot part or all of the bill to avoid a lawsuit.

Democratic lawmakers tweaked a previous plan to allow Minnesotans with incomes up to 600% of the federal poverty guideline who don't have insurance or whose insurance policy carries a deductible of $5,000 or more to access a 30-day supply of insulin. Diabetics in crisis could fill out forms at a pharmacy to prove they are eligible for the program and show a pharmacist an insulin prescription or out-of-date prescription to receive the drug.

That facet is key, insulin advocates said, as those living with diabetes can face fatal consequences if they don't have the insulin they need to manage their blood sugar levels.

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"This is truly an emergency in Minnesota, anybody who is doubting it or questioning it is flat wrong," Rep. Laurie Halverson, D-Eagan, who has Type 1 diabetes, said. “The problem is that insulin is too expensive."

But some worried that requiring drug companies to pay for the program would push the cost off to others who need insulin but aren't eligible for the program.

"You’re creating a perverse incentive for these insulin manufacturers to increase the rate," Rep. Jeremy Munson, R-Lake Crystal, said. "This will directly increase the price of insulin for people who are not on the program."

Republican senators also have put out a proposal that would require insulin manufacturers to supply the drug to patients with diabetes who are not already on a public health program and that make less than 400% of the federal poverty line. That would come out to roughly a $50,000 cap for individuals or $100,000 for a family of four.

Under the proposal, patients could fill out eligibility forms through the state's MNsure health insurance exchange website, which they could then submit to their doctors to obtain a 120-day refillable supply of insulin. They could be eligible through the program for one year before they would have to requalify.

Sen. Eric Pratt, R-Prior Lake, wrote that bill and said it would head off situations where people with diabetes ration insulin because of steep costs, preventing emergencies.

Insulin-access advocates, including two Minnesota mothers whose sons died of diabetes-related complications after they rationed insulin, said the lawmakers should consider passing both bills.

"These are two bills that would go hand-in-hand with each other," Nicole Smith-Holt, whose son Alec Smith died in 2017, said. "Alec’s bill was going to touch on that emergency situation, whereas the Pratt bill . . . it’s more of a once we get out of this emergency situation, this is the secondary bill."

Lawmakers suggested an openness to hash out a compromise in an informal conference committee. Gov. Tim Walz on Wednesday told reporters that he hoped legislative leaders could put together a panel of lawmakers to strike an agreement that could be acted on in a special session. Sen. Michele Benson, R-Ham Lake, in a statement said Walz should reach out to policymakers to talk about a special session. Benson chairs the Senate Health and Human Services Committee.

Attorney General Keith Ellison on Thursday also noted that the state is suing three insulin manufacturers for deceptive pricing practices. He said the lawsuit could help bring down the price of insulin in Minnesota and beyond.