On April 15, 2020, Governor Tim Walz signed into law the Alec Smith Insulin Affordability Act.
This bipartisan bill created an Insulin Safety Net Program to help qualified Minnesotans access a supply of prescription insulin at an affordable price.
Insulin is a hormone that naturally lowers the amount of glucose (a type of sugar) in the body. A person who is diabetic cannot naturally produce the levels of insulin they need and may need an insulin prescription from their doctor.
Many people with diabetes take insulin injections based on their blood glucose levels. There are short- and long-acting doses of insulin that are produced by multiple manufacturers.
Minnesota’s Insulin Safety Net Program allows a pharmacist to dispense the insulin as prescribed by a health care practitioner.
The safety net program does not cover:
The law established specific roles for both public and private entities.
MNsure’s responsibilities include conducting a public awareness campaign, training MNsure-certified navigators to assist Minnesotans with accessing insulin and providing compensation for eligible activities and maintaining a public list of navigators trained to assist individuals
The Minnesota Board of Pharmacy responsibilities include:
Office of the Legislative Auditor responsibilities include reviewing the program to determine if manufacturers are meeting their responsibilities, whether MNsure’s training program for navigators is adequate, and whether a sufficient number of navigators are providing assistance.
Minnesota Department of Health responsibilities include conducting a satisfaction survey of individuals who have accessed the program covering a variety of topics including whether they worked with a navigator and their satisfaction with that experience.
Minnesota pharmacies responsibilities include:
Insulin manufacturers responsibilities include creating an application for eligible individuals to access a continuing supply of insulin and supporting the application process.
Every outpatient and community pharmacy that is licensed by the State of Minnesota Board of Pharmacy is required to participate in the insulin safety net program.
Non-resident pharmacies, such as mail order pharmacies and inpatient hospital pharmacies, are not required to participate.
The Alec Smith Insulin Affordability Act created two different insulin assistance programs as part of the Insulin Safety Net Program.
These programs have different applications and provide urgent-need or long-term assistance.
Individuals that are in urgent need of insulin can access the application for an emergency supply of insulin online at mninsulin.org or complete an application at a pharmacy when filling their insulin prescription.
The pharmacist will dispense up to a 30-day supply of insulin and provide the consumer with a list of trained MNsure-certified navigators that can help them through the process of applying for continuing need insulin.
There are currently three manufacturers that supply prescription insulin Minnesota (Eli Lilly, Novo Nordisk and Sanofi).
Individuals that need a continuing safety net supply of insulin will complete an application for a manufacturer’s patient assistance program.
The manufacturer will process the application and determine eligibility for the continuing safety net program.
If an individual qualifies, they will submit the manufacturer’s eligibility statement, along with a valid insulin prescription, to a pharmacy to receive a 90-day supply of insulin, refillable up to 12 months.
MNsure-certified navigators with contracted agencies can assist individuals through the manufacturer’s patient assistance program application process and receive a payment for eligible activities.
The Alec Smith Insulin Affordability Act created an urgent need program which allows individuals to apply for a one-time, 30-day supply of insulin at their pharmacy.
An urgent need for insulin means an individual has less than a seven-day supply of insulin and that they will likely have significant health consequences if they run out of insulin.
Who qualifies for the urgent need program?
To be eligible for the urgent need program, an individual must:
What if an individual has health insurance?
If an individual has insurance that covers prescriptions, they may still be eligible to receive insulin on an urgent-need basis.
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-pockets costs include co-payments, co-insurance and deductibles.
The Minnesota Insulin Safety Net Program Application is available online at MNinsulin.org or the Board of Pharmacy website.
The application is a fillable PDF form that individuals can fill in electronically or by hand. The form must be printed and signed. Pharmacies may also have applications available to complete on-site.
MNsure-certified navigators may assist an individual with filling out an urgent need application. This may include printing the application from MNinsulin.org and helping individuals with Limited English Proficiency complete the form.
However, please note that helping a consumer apply for the Urgent Need Program is NOT an activity that is eligible for payment.
Individuals must show proof of Minnesota residency to the pharmacist in order to receive the urgent need insulin assistance.
Accepted forms of identification for proof of Minnesota state residency include:
The pharmacist will accept the application and confirm that a valid form of identification is presented. Every pharmacy located within Minnesota that is licensed as a community/outpatient pharmacy is required to participate in the program.
The pharmacist will dispense the prescribed insulin in the amount that will provide the individual with a 30-day supply.
If a prescription is written for a smaller quantity, the pharmacy cannot dispense a 30-day supply without contacting the prescriber.
The pharmacist will also notify the health care practitioner that the insulin has been dispensed and input a claim into a real-time database that tracks insulin assistance claims.
The pharmacist will retain a copy of the application form submitted by the individual for reporting and auditing purposes.
The pharmacist will give the individual an information sheet that lists all navigator organizations with staff trained to assist individuals with applying for continuing insulin assistance through a manufacturer.
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 $35 for the 30-day supply of insulin dispensed.
An individual who has already received a 30-day urgent need supply of insulin can receive a second 30-day supply if:
They have applied for Medical Assistance or MinnesotaCare, but eligibility has not been determined,
They are determined eligible for Medical Assistance or MinnesotaCare but coverage is not yet in effect, or
An insulin manufacturer has told the individual they are not eligible for the continuing need safety net program and the individual has requested an eligibility review by the Board of Pharmacy.
A pharmacist may refuse to fill an insulin prescription that would be covered under the program only if:
If a pharmacy does not have the insulin in stock, the pharmacist should work with the individual to determine if they can wait to fill the prescription until they are able to get it in stock. If not, the pharmacist should, whenever possible, assist the individual in locating another nearby pharmacy that does have the insulin in stock.
If a pharmacist believes that filling the prescription might be harmful, the pharmacist should contact the prescriber to discuss and resolve the concerns.
Pharmacists or their staff can assist in making sure that the application is correctly filled out.
An individual can file a complaint with the Minnesota Board of Pharmacy if a pharmacy does not fill an urgent need prescription.
You can find information and the process to file a complaint on the Board of Pharmacy’s website.
You can also call the Board of Pharmacy’s office at (651) 201-2825 or send them an e-mail at firstname.lastname@example.org to request a complaint packet.
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:
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.
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.
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.
Manufacturers may request proof of Minnesota residency. Accepted forms of identification for proof of Minnesota state residency include:
If the person who needs insulin is under the age of 18, the parent or legal guardian must provide valid proof of residency.
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.
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.
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.
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.
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.
A manufacturer must inform the applicant of the reason why they were denied eligibility for the continuing need program.
If an applicant still believes they are eligible for the program after receiving notification of denial, they can ask the Minnesota Board of Pharmacy to review their eligibility.
Reviews will only be completed for the continuing need program. The Board of Pharmacy will not review eligibility for other manufacturer assistance programs.
The applicant must fill out an eligibility review request form located on the Minnesota Board of Pharmacy’s website. A certified navigator can help with this activity.
An applicant can also call the Minnesota Board of Pharmacy’s office at 651-201-2825 to have a copy of the form mailed to them.
The following must be submitted to the Minnesota Board of Pharmacy for an eligibility review:
If the Board of Pharmacy does not receive all of the documents necessary to conduct a review, the Board will ask the applicant to submit the missing documents.
Documents should be mailed to the Board of Pharmacy at:
Minnesota Board of Pharmacy
2829 University Avenue SE #530
Minneapolis, MN 55414
Documents may also be faxed to the Board of Pharmacy at: 612-617-2262
The Minnesota Board of Pharmacy will notify the applicant of their decision within 10 business days. The applicant will receive a decision by mail.
The decision of the Board of Pharmacy is final and cannot be appealed.
The Alec Smith Insulin Affordability Act requires MNsure to train and compensate MNsure-certified navigators that assist individuals with accessing an insulin manufacturer’s patient assistance program.
The statute appropriated $189,000 for application assistance bonus payments. This funding is a one-time appropriation from the state of Minnesota’s Health Care Access Fund. This funding will be available until December 31, 2024.
A navigator is eligible for an insulin assistance payment if:
For more information, refer to the Navigator Insulin Payment Policy on Assister Central.
A navigator is eligible for a single, one-time payment for assisting an individual with one or a combination of the following activities:
Note: If a family has more than one individual who qualifies for the program, each individual needs their own application. Each application is then eligible for payment.
The following are activities that are not eligible for a navigator insulin assistance payment:
Navigators must submit a completed Insulin Case Association Form within 30 days of assisting an individual in order to receive payment for an eligible activity. The form is only available online.
All required fields must be filled in. Incomplete forms will not be processed. The online submission form will not allow a navigator to submit an incomplete form.
The form should be completed in one sitting.
The navigator insulin payment form asks for the following information:
MNsure will issue payments to eligible organizations on a quarterly basis based on timely submission of the required Insulin Case Association Form.
Payments will be issued within 60 days following the end of the quarter.
The payment rate may vary by quarter but will be no less than $25 per case and no more than $70 per case.
The payment rate will be dependent on the amount of funding available for the quarter and the number of valid Insulin Case Association Forms submitted.
Resources for assisters who have questions and need additional information when helping consumers with insulin assistance.
MNInsulin.org provides information on how to access the urgent need safety net program, including:
Individuals can also search MNsure’s Assister Directory to find a navigator to help them apply for the continuing need program.
The Insulin Safety Net Program page on the Minnesota Board of Pharmacy’s website provides information for individuals on the urgent need program and continuing need program. This page includes:
The Minnesota Board of Pharmacy offers additional resources for individuals looking for savings on prescription drugs, including:
All resources for navigators related to the Minnesota Insulin Safety Net program are available in the Insulin Assistance Program section of Navigator One Stop on MNsure Assister Central.
The ARC can answer Medical Assistance and MinnesotaCare eligibility questions; however, it cannot provide support for the insulin urgent need or continuing need programs.
For example, the ARC is not able to:
There are currently three insulin manufacturers that are required to participate in the continuing need insulin program.
Each manufacturer maintains a resource page for individuals applying for insulin on a continuing need basis.
If an individual is not able to access insulin through the insulin safety net program, there may be other options available.
The Federal 340B drug pricing program allows qualified health care organizations to purchase drugs at substantially lower prices. Those organizations can dispense drugs at a reduced rate to their patients.
Navigators can help an individual search to see if their current provider is a 340B entity. A user can search by the city and state.
The individual will need to check with their provider and pharmacy to determine whether their prescription qualifies.
More information is available on the Minnesota Board of Pharmacy Insulin Safety Net Program webpage.