October 03, 2022
To: State Department Directors and Autonomous Agency Heads
From: Governor Gretchen Whitmer
According to the Center for Disease Control, more than 10 percent of Michiganders have diagnosed diabetes, and they shoulder more than double the medical expenses of those who do not have diabetes. Nearly 3,000 deaths a year in Michigan are attributed to diabetes.
Insulin, the most prescribed treatment for diabetes, is a century-old, life-saving drug that
hundreds of thousands of Michiganders need to survive. In the United States, insulin costs
nearly 10 times as much as in other countries, and 1 in 3 diabetics routinely make
impossible choices between purchasing insulin and fulfilling their other basic needs, like
buying groceries or keeping the heat on.
The egregiously high cost of insulin is unsustainable. My administration is committed to
making insulin available to those who need it at an affordable price.
We have already taken steps to lower health care costs for seniors and those receiving
health insurance subsidies. Executive Directive 2022-9 ensures that Michiganders receive
the full extent of the savings made possible by the Inflation Reduction Act (IRA). ED 2022-9 also instructed the Michigan Department of Health and Human Services to continue efforts to decrease the cost of prescription drugs for Michigan Medicaid recipients.
There is more work to be done. The IRA limits health care costs for seniors on Medicare by
capping the out-of-pocket cost of insulin at $35 a month and total prescription drug costs at
$2,000 a year. But many Michiganders who need life-saving insulin are not covered by the
IRA, including the uninsured and those who face large out-of-pocket costs under their
private insurance plans. While the House of Representatives has voted on legislation to
extend cost caps, further federal action remains uncertain.
We cannot wait. We must take immediate action to make insulin affordable for
Michiganders while creating jobs in the state. We cannot allow the opaque pricing practices
of drug manufacturers and massive health care corporations to force people to ration or
forgo insulin just so they can keep a roof over their heads and food on the table. We must
explore every option to lower costs for consumers.
Acting under sections 1 and 8 of Article 5 of the Michigan Constitution of 1963, I direct the
following:
1. Departments and agencies covered by this section must review aspects of insulin
purchasing, distribution, and production within their jurisdictions and identify and
assess potential opportunities to lower costs for Michiganders who purchase insulin.
Covered departments must provide a report to the Executive Office of the Governor
detailing their conclusions about such opportunities no later than December 20,
2022.
The report must:
(a) Provide the covered department’s assessment of the following approaches to
lower insulin costs:
(1) Development, in conjunction with a partner or partners, of novel low-cost interchangeable biosimilar insulin or other insulin product for
distribution in Michigan;
(2) Production, purchase and/or distribution by the state or by the state in
conjunction with other entities of low-cost interchangeable
biosimilar or other insulin products; and
(3) Establishment of a Michigan-based insulin manufacturing facility by
the state or by the state in conjunction with other entities, including any
potential sites for such facility.
(b) Supply information about any additional actions that the state could take
that would, in the view of the covered department, feasibly lower insulin
costs for consumers; and
(c) To the extent possible, assess the state resources that would be required to
undertake each action, the timeline of the action, and potential cost savings to
the state or to individual consumers.
The covered departments are the Department of Health and Human Services, the
Department of Insurance and Financial Services, the Department of Labor and
Economic Opportunity, the Department of Licensing and Regulatory Affairs, the
Department of Technology, Management, and Budget, and the Department of
Treasury. The Michigan Economic Development Corporation should provide a report
and participate in any further study.
2. Following receipt of the reports, the Executive Office of the Governor will convene all
relevant departments and agencies to further assess actions that the state can take to
lower the cost of insulin for Michiganders.
3. All departments, committees, commissioners, or officers of this state must give any
necessary assistance required to implement this directive, so far as is compatible
with their duties and consistent with this order and applicable law. Free access also
must be given to any books, records, or documents in their custody relating to
matters within the scope of inquiry, study, or review, consistent with applicable law.
This directive is effective immediately.
Thank you for your cooperation in its implementation.
Click to view the full PDF of the executive directive.
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