Keep working on an insulin solution for Minnesota

Minnesotans share your heartbreak, Nicole Smith-Holt. The last-minute failure by legislators to pass an emergency insulin supply bill casts a pall over the 2019 session and, sadly, leaves diabetics across the state to ration or even forgo this lifesaving medication if they can't afford it.

The 2017 death of Smith-Holt's son, Alec, became a tragic illustration of rising drug prices' dire consequences. Alec, 26, who aged off his mother's insurance plan, couldn't afford his own coverage. An autopsy found he'd suffered a critical shortage of insulin, according to a 2018 Star Tribune report.

Smith-Holt is undaunted by the Legislature's dereliction of duty, saying this week that she will not "back down." That is exactly the right attitude, but she ought not be forging ahead on her own. Gov. Tim Walz, state health officials, medical providers, pharmacists, drug companies and lawmakers need to act now on emergency insulin and the broader issue of rising drug prices.

Stopgap solutions to provide insulin for those in crisis are needed before the 2020 Legislature convenes. The work to tee up legislation for the next session also must begin now. A key reason this year's historic elder-care reforms were passed is that advocates and industry representatives met throughout 2018 after a first attempt at fixes crashed at the Capitol.

A Star Tribune commentary by state Sen. Jim Abeler and Republican colleagues published this week captured this can-do attitude. They propose having the state Department of Human Services (DHS) set up an emergency insulin program and calling a special legislative session to authorize it. Unfortunately, this "simple" solution would be complex and likely unworkable in the short-term. Key reasons: the state's aging pharmacy payment technology and the challenge of implementing eligibility criteria to prevent fraud and abuse.

But — like Smith-Holt — Abeler and colleagues have the right attitude: Keep going. Their get-it-done spirit should have kicked in earlier, when GOP concerns about insulin legislation could have been addressed, but it's now time to look ahead.

A first step is putting in place the policymaking structure to recommend solutions. The working group used by the elder-care community offers a model. Walz needs to take the lead on setting this up. A question that needs addressing: Could the prescription drug price task force launched by state Attorney General Keith Ellison serve this purpose?

Short-term solutions for emergency insulin access are also needed. A survey of the state's medical community by an editorial writer didn't yield any ideas for quick, easy fixes — because there are none. But there are worthwhile avenues to explore:

• Increase awareness of lower-cost insulin. Older versions of insulin may cost less than half of what modern rapid- or longer-acting insulins do, according to GoodRx.com. Yet many don't realize this. A campaign led by the state's doctors or Health Department to encourage cost-conscious patients to inquire about this, and physicians to inform them, would be helpful.

• Ask Minnesota's nonprofit hospitals and insurers to fund and implement a temporary emergency insulin program as part of their "community benefit." Their nonprofit status provides preferential tax treatment with the expectation these organizations will use returns to boost public health. Here's an innovative twist on that.

• Pressure insulin makers to help fund a temporary program. The average cost of insulin therapy tripled between 2002 and 2012, according to GoodRx.com, and prices have risen 64% since 2014. Such a program would be a public-relations boost.

• Improve outreach to uninsured individuals who may be eligible for medical assistance or MinnesotaCare. Both programs provide robust drug coverage. A 2018 report found that 51% of the state's uninsured could qualify.