Lowering the cost of insulin and other prescription medications has become a shared goal for Democrat and Republican elected officials, whether they're southwest metro legislators and candidates or President Donald Trump.
Several local and federal proposals, including caps on prices or copays and a state emergency insulin supply program, have drawn at least a sliver of bipartisan support in otherwise polarized times.
But major divisions and disputes over how to make health care cost less remain, and not just between the two major parties, stalling several of the plans. The state and federal governments also have different playing fields for tackling the issue.
"We’re kind of frustrated here at the state level, but we’re going to keep trying," said state Rep. Laurie Pryor, DFL-Minnetonka.
The price of insulin for people with diabetes has multiplied in the past decade to several thousands of dollars a year, and this year a Minnesota man, Jesimya Scherer-Radcliff, died after his family said he had rationed the drug because it cost too much.
Minnesota legislators in both parties soon after began drawing up plans for a program providing insulin supplies to those who couldn't afford or access the lifesaving hormone, which helps control blood sugar levels.
Several of those officials, including Sen. Eric Pratt, R-Prior Lake, at a public meeting this week said they had broadly agreed on some ways the program should work, including a possible role for pharmacists and the need for a combination of emergency supplies with a longer-term fix.
Pratt said he'd also like the program to steer uninsured participants into some kind of coverage that they qualify for, such as the state Medicaid program or private insurance with public assistance.
"We don’t want them to be uninsured," he said Wednesday at the Capitol. "They might be able to get into an insurance program today that is affordable and they didn’t know about it."
Disagreement remains on several points, however.
Several Democrats favor charging a fee for insulin manufacturers to help pay for the program and want pharmacists to play a primary role, for instance. Representatives of the state's physicians and pharmacists associations at the meeting said they supported the pharmacy focus.
Senate Republicans want physicians involved and point out some manufacturers and insurers have capped insulin costs for Minnesota patients at $25 a month or less in recent months. The state this year made it illegal for insurers to profit from insulin, according to the Star Tribune.
Rep. Michael Howard, DFL-Richfield, said he believed a full agreement could still come by the end of the year.
"We’ve made a lot of headway. I feel really confident that we can get there," he said.
The problem of diabetes and affordable treatment goes beyond insulin, several people said at a Prior Lake forum Pratt held on the issue in October. Joni Stark, whose 24-year-old son is diabetic, said the supplies, pumps, doctor's visits and other expenses pile up.
Why do companies have to make money for patients to live, Stark asked.
"It shouldn’t have to be this way," she said.
Pratt and other attendees Wednesday also noted other medications besides insulin are expensive and essential, too. Dave Renner, advocacy director at the Minnesota Medical Association, called for bipartisan work on the entire issue of drug costs instead of covering one condition after another.
Widening the scope
Several state and federal proposals with local involvement aim to do just that by setting drug-price ceilings, allowing re-importation of medicine from Canada or government price negotiations, or taking other tacks.
Angie Craig and Dean Phillips, both Democrats representing Minnesota districts in Congress, and other House members this month approved the Lower Drug Costs Now Act to allow the federal government to negotiate lower Medicare prices for hundreds of drugs, which is prohibited under current law.
Among other provisions, the bill would also extend those lower prices — including for insulin — to private plans, such as policies that come through a patient's job.
The Congressional Budget Office, a non-partisan group that tallies and forecasts bills' impact on government spending, found the bill would save hundreds of billions of dollars on drugs over the next decade while sending most of those savings into more Medicare coverage and other uses.
"Frankly it’s just time that we stand up to brand-name pharma in this country," Craig said during a call with reporters on Dec. 11. "This is just a critical first step."
Rick Olson, a Prior Lake Republican planning to run against Craig next year, said he reluctantly supported allowing more negotiation.
"I don’t like the idea, I’m a free-market person," he said. "But when a market is so broken, you’ve got to figure out how to re-engineer the whole thing."
Pharmaceutical companies and Republicans who control the Senate, meanwhile, have opposed the plan, saying lower prices means less money for crucial research and development of some new medications.
The Congressional Budget Office projection affirmed that concern, but Democrats say giving some of the savings to more research will make up for the loss.
Republican U.S. Sen. Chuck Grassley of Iowa has proposed a plan that includes many of the House's policies except for the Medicare price negotiation. Like Craig's bill, it would cap out-of-pocket drug costs for Medicare enrollees and make drug manufacturers pay back Medicare if their prices rise faster than inflation.
Grassley has Trump and some Democrats' support, but Senate Majority Leader Mitch McConnell and other Republicans oppose it because of the payback piece, according to The Hill and other news outlets.
A similar situation is playing out in Minnesota, said state Sen. Scott Jensen, R-Chaska.
Jensen, who is a family doctor, and Pryor this year introduced a bill to create a state drug affordability commission that could set drug price ceilings and require manufacturers to publicly justify high or increasing drug prices. Jensen said his Republican colleagues largely weren't interested, worried about excessive regulation.
It's unclear if the state can legally set ceilings, Pryor said, but even a commission's public finding of what a fair price is would be worthwhile. Rep. Kelly Morrison, DFL-Deephaven, has authored a bill creating a similar drug price transparency commission.
"There’s a lot of evidence that some of these prices are excessive, and that’s what we keep coming back to, whether it’s EpiPens or insulin," Pryor said.
Rep. Tony Albright, R-Prior Lake, said government price controls could lead to controls on doctors' fees and other aspects of health care by a "bureaucratic force" when innovation and letting market forces do their work are the better way.
"I think it's a really slippery slope," he said.
Dr. Andrea Nelsen, a Prior Lake psychiatrist and Democrat who is running against Albright next year, said she supported cost controls to try to get some of the drive for profit out of health care.
"It's the Wild West with prescription drugs right now," she said in an interview Thursday. Many of her patients can't get the medicines they need and so avoid care, get worse and cost everyone more in emergency rooms. The U.S. Department of Veterans Affairs can negotiate medication prices, she noted.
"Why can't Medicare? Why can't everybody else?" Nelsen said.