Greed v. Alec’s Law: Oral Argument at the Eighth Circuit

Greed v. Alec’s Law: Oral Argument at the Eighth Circuit

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T1International is proud to join T1International’s Minnesota #insulin4all Chapter and patient advocates at the oral argument before the United States Court of Appeals for the Eighth Circuit (Eighth Circuit) in support of upholding Minnesota’s Alec Smith Insulin Affordability Act (Alec’s Law) on December 15, 2021.

In the United States, 1 in 4 people ration their insulin due to the high cost of the medication. That number is much higher among communities historically excluded due to race, ethnicity, gender, sexual orientation, gender identity or expression, and immigration status among many others. Until action is taken at the Federal level, states including Minnesota need to be able to take action to prevent death by rationing, and Alec’s Law does just that. Depending on the outcome of this argument, the diabetes community will learn just how far the courts prioritize patients over profits.

Passed in April 2020, Alec’s Law is named after Alec Raeshawn Smith, a 26-year-old who died in 2017 from rationing insulin. The Minnesota state law provides three protections to patients: (1) an insulin safety net program that allows residents living with diabetes to purchase a 30-day supply of insulin at their pharmacy for a co-pay of $35 once per year, (2) long-term protections for low-income individuals who need insulin but may not qualify for drug manufacturer assistance programs, and (3) a plan to fine insulin manufacturers that refuse to participate in the insulin safety net program. Insulin manufacturers are required to supply the insulin for free or reimburse pharmacies that provide insulin under this law.

Alec’s Law isn’t perfect. For example, the law was unable to include individuals who are undocumented, which is a gap we fought and hope to close in future.

It has been nearly 20 months since this program was put into place. It is estimated that in the first five-month period after Alec’s Law went into effect, 465 people were directly benefited by the safety net programs it created. This safety net program doesn’t cost taxpayers money and saves lives.

Insulin manufacturers Eli Lilly, Novo Nordisk, and Sanofi immediately and strongly opposed the legislation and threatened to sue the state of Minnesota if it adopted Alec’s Law. True to form, in June 2020, a pharma industry trade group that includes these companies—the Pharmaceutical Research and Manufacturers of America (PhRMA)—filed a lawsuit before the United States District Court of Minnesota (District Court) to stop the law from going into effect. In November 2020, T1International, Minnesota #insulin4all, the National Health Law Program (NHeLP), and Mid-Minnesota Legal Aid (MMLA) filed an amicus brief in District Court to provide additional information to the court in support of Alec’s Law and the State of Minnesota, lifting up the experiences of several Minnesota residents whose lives have been affected by the high price of insulin.

In March 2021, the District Court rejected PhRMA’s challenge and dismissed the lawsuit. T1International celebrated the lawsuit’s dismissal, but PhRMA appealed the pharmaceutical’s industry’s loss to the Eighth Circuit. In June 2021, T1International, Minnesota #insulin4all, NHeLP and MMLA submitted another amicus brief urging the Eighth Circuit to uphold the decision of the District Court.

Eighteen months since Alec’s Law went into effect, patients are still having to defend the right to an insulin safety net. On December 15th, the Eighth Circuit will hear the oral arguments from PhRMA and the Minnesota Board of Pharmacists. The Eighth Circuit will decide at a later date whether the District Court’s decision of dismissing PhRMA’s lawsuit will be upheld. We remain hopeful that the Eighth Circuit will agree with the decision of the District Court and allow Alec’s Law to continue benefiting people living with diabetes. The decision from the District Court earlier this year to dismiss PhRMA’s lawsuit was a pivotal moment in the history of our fight for #insulin4all. A victory at the Eighth Circuit would reaffirm that the lives of people like Alec Smith are worth more than the profits and greed of pharmaceutical companies and that state governments across the country have the power to intervene to save lives.

Part of what makes Alec’s Law so important is that it has served as an inspiration for similar bills across the country. Colorado and Maine successfully passed Alec’s Laws this year. States inspired by Alec’s Law continue to take action and create policies aiming to save lives during this insulin pricing crisis.

T1International’s Minnesota #insulin4all Chapter will be hosting a press conference on Wednesday, December 15th, 2021 in front of the Federal Court Building in St. Paul moments before the oral arguments begin. The T1International community will be attentive and standing in solidarity with Minnesota on that day.


Elizabeth Pfiester, Executive Director & Founder, T1International
Every day, our community hears and shares new stories of people facing difficult situations and forced to make impossible choices to try to access the insulin they need to survive. Stories like Alec Smith’s are unfortunately not unique. PhRMA is willing to go very far in an attempt to take away what for many can be the last opportunity to survive in the name of their profits. It demonstrates the urgency to continue working towards ensuring that insulin remains truly accessible and affordable for all.

Nicole Smith-Holt, T1International Ambassador, Mother of Alec Smith
As the mother of Alec Smith - age 26 when he died from rationing his insulin due to cost, I plead with the courts to uphold the decision from the district courts. Now more than ever we need Alec's Law in place, during the pandemic we have seen first hand that our healthcare system is broken. Lives are at risk when there is no safety net in place and Alec's law is a much needed safety net for the people of Minnesota.

Wayne Turner, Senior Attorney, National Health Law Program (NHeLP)
Pharmaceutical companies continue to raise insulin prices exponentially, while people with diabetes literally pay with their lives. We are proud to support efforts in Minnesota and elsewhere to make insulin and other life-saving medications affordable and accessible. NHeLP will also continue to push for meaningful drug pricing reform at the federal level, and requiring health insurers to pass lower costs onto consumers.

Related posts:

T1International, Minnesota #insulin4all, and Partners Submit Amicus Brief for Alec Smith Bill

T1International, Minnesota #insulin4all, and Partners Submit Amicus Brief for Alec Smith Bill

There is an insulin rationing crisis in the United States, driven by the high price of this life-saving medication. Research indicates that one-quarter of people with diabetes have to ration their insulin because of the cost, and rationing puts patients at greater risk of health complications, including death. In Minnesota, advocates responded to the deaths of Alec Raeshawn Smith and Jesimya David Scherer-Radcliff by fighting to pass the Alec Smith Insulin Affordability Act, which was the first in the nation to establish a program for patients with diabetes to purchase the insulin they need at an affordable price. After years of work, this bill was signed into law by Governor Tim Walz on April 15, 2020. Read more

T1International Statement on Pharma’s Attempt to Block Minnesota’s Insulin Bill

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T1International is outraged, though not surprised, to see pharmaceutical companies once again put profit over human lives. On Tuesday, the Pharmaceutical Research and Manufacturers of America (PhRMA) filed a lawsuit against the state of Minnesota to challenge the Alec Smith Insulin Affordability Act. Read more

Advocates Celebrate Passage of Alec Smith Bill in Minnesota

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After months of diligent advocacy, partisan gridlock, and intense negotiations, the Alec Smith Emergency Insulin Bill was signed into law today in Minnesota. Alec’s Bill is named for 26-year-old Alec Smith, who passed away after rationing his insulin in 2017. The legislation, which is the first of its kind in the nation, establishes a program for patients with diabetes to purchase the insulin they need at an affordable price. To get to this moment, advocates in Minnesota endured a tough - and long - fight. Read more