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:
- be a resident of Minnesota and be able to provide proof of residence.
- not be enrolled in Medical Assistance or MinnesotaCare.
- be in urgent need of insulin with less than a seven-day supply ready for use, and risk significant health issues without it.
- not have received an emergency 30-day insulin supply within the last 12 months (some exceptions apply).
- be able and willing to attest that they meet the above requirements.
- and present a valid 30-day insulin prescription from their doctor or have a prescription on file with the pharmacy.
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.
Applying for the Urgent Need Program
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.
Identification for Urgent Need Insulin
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:
- 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.
Accessing Urgent Need Insulin: Filling an Insulin Prescription
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.
Co-pay for an Urgent 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 $35 for the 30-day supply of insulin dispensed.
Second Urgent Need Supply of Insulin
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.
Pharmacy Refusal to Participate
A pharmacist may refuse to fill an insulin prescription that would be covered under the program only if:
- The pharmacist believes that filling the prescription could be harmful to the patient;
- The pharmacy does not have the insulin in stock;
- The application for the Urgent Need Program is not correctly filled out and signed; or
- The patient refuses to pay the co-pay.
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.
Filing a Complaint (NEW)
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 email@example.com to request a complaint packet.