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.
Eligibility for Payment
A navigator is eligible for an insulin assistance payment if:
- They are actively certified with an agency that has executed a contract amendment with MNsure for assisting individuals in applying for the Insulin Safety Net Program (Attachment C).
- They have completed the online insulin program training.
- They have submitted a completed Insulin Case Association Form online to MNsure within 30 days of assisting an individual with an eligible activity.
- The navigator agency has not received a navigator per-enrollee payment for the same individual within the past 12 months.
- Funding is still available.
For more information, refer to the Navigator Insulin Payment Policy on Assister Central.
Activities Eligible for Payment
A navigator is eligible for a single, one-time payment for assisting an individual with one or a combination of the following activities:
- Completing a manufacturer’s application for the patient assistance program.
- Submitting additional information as requested by the manufacturer to verify the individual’s eligibility.
- Submitting a review of manufacturer’s eligibility to the Board of Pharmacy.
- Filling an insulin prescription once approved by a manufacturer’s patient assistance program.
- Accessing an additional 30-day urgent need insulin supply for eligible individuals, including checking MNsure eligibility status.
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.
Activities NOT Eligible for Payment
The following are activities that are not eligible for a navigator insulin assistance payment:
- Assisting an individual with applying for only the urgent need supply of insulin (unless the individual has applied with a manufacturer and requires an additional 30-day urgent need supply of insulin).
- Providing information regarding other affordable insulin assistance programs.
- Assisting an individual with insulin program activities when the navigator agency has already received payment for the same individual within the past 12 months.
Requesting Payment Process
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.
Completing the Insulin Case Association Form
The navigator insulin payment form asks for the following information:
- Navigator ID
- Navigator organization
- First and last name of the individual who applied
- Date of birth of the individual who applied
- City where the individual applied lives (or indicate if individual is homeless)
- Date of insulin application (if known)
- Which insulin manufacturer the individual applied with
- What eligible activity/activities the navigator assisted the individual with
- Individual’s signature or verbal consent
- Signature date
Payment Distribution
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.
For example:
- A navigator assists an individual on January 20 and submits the Insulin Case Association Form on February 15. The form will be processed as part of the first quarter of the year and payment will be issued at the end of May.
- A navigator assists an individual on March 30 and submits the Insulin Case Association Form on April 10. The form will also be processed as part of the first quarter of the year and payment will be issued by the end of May.
Payment Amount
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.
