Individuals who are in need of insulin beyond the initial 30 days can apply for insulin on a continuing need basis.
To be eligible for the continuing need program, an individual must:
- Be a resident of Minnesota and be able to provide identification of proof of residence.
- Not be enrolled in Medical Assistance or MinnesotaCare.
- Have a family income that is equal to or less than 400% of the federal poverty guidelines income.
- Not be eligible to receive prescription drug benefits through the Department of Veterans Affairs.
- Not be eligible to receive health care through most federally funded programs. However, an individual who is enrolled in Medicare Part D is eligible for continuing need insulin assistance if the individual has spent $1,000 on prescription drugs in the current calendar year and meets the other eligibility requirements.
What if an individual has health insurance?
If an individual has health insurance that covers prescriptions, they may still be eligible to receive insulin through the continuing need program.
If they pay $75 or less in out-of-pocket costs, for a 30-day supply of insulin, they will not be eligible. Out-of-pocket costs include co-payments, co-insurance and deductibles.
Federal Poverty Guidelines Calculation
The DHS income guidelines table shows the calculations for family income that is equal to or less than 400% of the federal poverty guidelines income.
You can use this table to help determine if an individual may be eligible for the continuing need program.
Applying for the Continuing Need Program
Navigators can assist individuals in applying for the continuing need program by completing an application through an insulin manufacturer’s website.
Manufacturers’ application processes may differ, but all manufacturers are required to meet the minimum eligibility standards of the continuing need program.
Identification for the Continuing Need Program
Manufacturers may request proof of Minnesota residency. Accepted forms of identification for proof of Minnesota state residency include:
- Valid Minnesota driver’s license
- Valid Minnesota identification card (which can be an identification card issued by a tribe located within Minnesota) or
If the person who needs insulin is under the age of 18, the parent or legal guardian must provide valid proof of residency.
Eligibility Determination for the Continuing Need Program
The manufacturers determine eligibility for the continuing need program using guidelines that are monitored by the Board of Pharmacy.
The manufacturer must inform an applicant if they are eligible within ten business days of receiving a completed application.
The manufacturer can request additional information within five business days of receiving a completed application but must inform the applicant if they are eligible within three business days of receiving the additional information.
Eligibility for Other Programs Offered by a Manufacturer
After the manufacturer reviews the application, it may be determined that an applicant with health insurance that has co-payments would better benefit from an insulin co-payment assistance program offered by the manufacturer.
If a manufacturer can offer better benefits or benefits equal to what is provided by the Minnesota Insulin Safety Net program, the manufacturer can offer those benefits instead.
However, if a manufacturer reduces or ends the benefit program, they must still offer a program at least equal to the Minnesota Insulin Safety Net Program, as required by state law.
If the manufacturer determines an applicant is eligible for continuing need insulin assistance, they will send an eligibility statement, which will be valid for 12 months.
The eligibility statement might be in the form of a card containing information that a pharmacy will need when it fills the insulin prescription.
However, the law does not say how the eligibility statement needs to be prepared so the manufacturer may send a letter instead.
In the case where applicants with health insurance qualify for a co-payment assistance program, the manufacturer must provide coupons that the individual can use at the pharmacy to have their co-payment reduced or eliminated.
Providing Information at the Pharmacy
Individuals will need to provide the pharmacy with their statement of eligibility or card that they received from the manufacturer and the prescription for insulin from their provider, unless the prescription is already on file at the pharmacy.
It is recommended that individuals work with their pharmacy a couple of weeks in advance of running out of insulin.
The pharmacy will then submit an order to the manufacturer for a 90-day supply of insulin.
Co-pay for Continuing Need Supply of Insulin
The pharmacy may collect an insulin co-payment from the individual to cover the pharmacy’s costs of processing and dispensing in an amount not to exceed $50 for a 90-day supply of insulin.
Minnesota Department of Health Survey
The Minnesota Department of Health (MDH) will conduct a satisfaction survey for individuals who have used the urgent need and/or continuing need programs.
The survey information will be available on the Minnesota Department of Health website.
The survey will include questions asking the individual if they received help from a certified navigator and if they were satisfied with the help they received.