Alec Smith turned 26, aged off his mother's health insurance, and — facing insulin that cost him roughly $1,300 a month out of pocket — did what too many diabetics do when the price is impossible: he rationed. He died in 2017, alone in his apartment, before his next paycheck. Insulin has existed for a century. Its inventors sold the patent for a dollar because they thought no one should profit from a molecule people need to live. Alec Smith died anyway, because of what it costs.
Minnesota's answer bears his name.
What the law guarantees
The Alec Smith Insulin Affordability Act, Minn. Stat. § 151.74, builds two safety nets and puts the obligation on the manufacturers who make the product.
The urgent-need program: if you're a Minnesota resident with less than a seven-day supply and no affordable way to get more, you fill out a one-page form, take it and your prescription to a pharmacy, and the pharmacist must dispense a 30-day supply — with your co-pay capped by statute at no more than $35. The manufacturer, not the pharmacy, eats the cost. You can't be turned away in a crisis for inability to pay.
The continuing safety-net program: for lower-income Minnesotans who are uninsured or underinsured, the manufacturers must provide insulin through their patient-assistance programs for up to a year at a time, with an independent review panel — not the drug company — getting the final say on eligibility appeals. Small manufacturers and genuinely cheap insulin are exempted, so the burden falls where the profits are.
Then the manufacturers sued
Here's the part that tells you who this fight is really between. The Pharmaceutical Research and Manufacturers of America — PhRMA, suing on behalf of Eli Lilly, Novo Nordisk, and Sanofi, the three companies that make essentially all the insulin sold in America — went to federal court to have the law struck down. Their theory: forcing a company to hand over its product for free is an unconstitutional "taking" of private property under the Fifth Amendment, the same clause that stops the government from seizing your house without paying you.
The case is Pharmaceutical Research and Manufacturers of America v. Williams, 64 F.4th 932 (8th Cir. 2023). The trial court threw PhRMA's suit out for lack of standing. The Eighth Circuit reversed that — it held PhRMA could bring the case — but pointedly declined to decide whether the law is actually an unconstitutional taking, sending that question back down for the trial court to answer. So as of now the constitutional question is genuinely open, the litigation grinds on, and — this is the important part — the program remains in effect. Minnesota's Attorney General is defending it, joined by the diabetics and advocates, including Alec Smith's mother, who fought for the law in the first place.
The honest hard part
I'm a lawyer, and I won't pretend the manufacturers' argument is frivolous. Compelling a private company to give away its product for free does raise a real constitutional question — the government generally has to pay when it takes property, and "make the drug company provide it at a loss" is not nothing. Reasonable judges can disagree about where the line is, which is exactly why the Eighth Circuit didn't pretend the answer was easy.
But notice the shape of it. A young man died because a life-saving product was priced out of reach. A state made the product available in an emergency. And the response of the companies that set the price was to argue, in federal court, that being required to help is a violation of their rights. That contrast is the whole argument for why we need people in office who will defend these laws all the way up.
What we can do
Defend the Act in court, without blinking. The manufacturers have the lawyers and the patience to litigate for years. The state's job is to out-last them, because the program only helps people so long as it survives. This is a core Attorney General function.
Pair the safety net with price limits. A free emergency supply is a floor, not a solution. Minnesota's $35 monthly co-pay cap for insured patients was the right next step; the longer game is attacking the list price itself through the drug-pricing tools the state now has.
Make sure people know it exists. An urgent-need program only saves a life if the person in crisis, or the pharmacist, or the ER nurse, knows to reach for the form. Awareness is the cheapest life-saving investment there is.
No one in Minnesota should die the way Alec Smith did. The law that carries his name makes sure they don't have to. Keeping it means defending it — against some of the best-funded litigants in the country.
First the facts. Then the fix.
Sources
Minn. Stat. § 151.74, the Insulin Safety Net Program (the Alec Smith Insulin Affordability Act), verified against raw text at revisor.mn.gov: the urgent-need program (subd. 2–3), including the 30-day supply and the statutory co-pay cap of no more than $35; the continuing safety-net program and manufacturer patient-assistance obligations (subd. 5), with the Board of Pharmacy review panel; and the small-manufacturer and low-cost-insulin exemptions (subd. 1). Litigation: Pharmaceutical Research and Manufacturers of America v. Williams, 64 F.4th 932 (8th Cir. Apr. 3, 2023), read in full on CourtListener — the Eighth Circuit reversed the district court's dismissal for lack of standing and rejected the sovereign-immunity bar, while expressly declining to decide the merits of the Takings Clause claim ("We decline PhRMA's invitation to decide the merits of their claim") and remanding; the plaintiff sued on behalf of Eli Lilly, Novo Nordisk, and Sanofi, with amici including T1International, Minnesota #insulin4all, and Nicole Smith-Holt. Alec Smith's story (aged off insurance at 26; died July 2017 while rationing insulin) is a matter of extensive public record.
The current district-court posture on remand and the separate $35 insured co-pay cap's exact citation were not re-pulled this pass and are described in general terms. Corrections: campaign@madgettformn.com.