A group of Minnesotans with diabetes plan to cross the border into Canada again this week to buy insulin for a fraction of what it would cost them here.

It is illegal to import prescription drugs from another country, but people are increasingly turning to such options as insulin prices in the U.S. soar. The alternative — rationing insulin or going without it — can lead to serious health problems, including blindness, kidney failure or even death.

U.S. Senator Tina Smith, D-Minn., is proposing legislation, now with bipartisan support, that aims to lower the cost of insulin and make it more readily available for people without insurance. MPR News host Cathy Wurzer spoke with Sen. Smith about the bill.

This transcript has been lightly edited for clarity. Click on the audio player to hear the full interview.

Cathy Wurzer: You have a lot of things going on in this bill: penalties, competition, transparency. Let's try to parse some of this, and I'm going to start with skyrocketing costs. You are calling for increased competition to lower prices, but with only, what, three major makers of insulin, how would increased competition help lower prices?

Senator Tina Smith: Well, I want to first say that I was inspired to do this bill because of the Minnesota insulin advocates like Nicole Smith-Holt and Lija Greenseid who've been so strong on this. I first met them a year ago, and they started to help me understand how rationing of insulin is such a big deal, and I just couldn't believe that it was so prevalent, so I went to work on this bill.

One of the challenges that we have is that as you point out, there are three manufacturers of insulin and they have been raising their prices in lockstep over the last several years. One raises their prices and then the next one does, and so the first thing my bill does is it gives states the ability to provide an emergency supply of insulin when people need it. But then it goes farther, and it says that we are going to make it easier for the lower-cost generic insulin drugs to come onto the market, which is a big deal. These generics cost a lot less, but because of the unfair market power that these big drug companies have, they are able to keep their competition off the market for 12 years. That's their current market exclusivity. And so we bring that down, and then we also penalize them if they raise their prices more than 10 percent a year, which is still a lot. We say if you do that, we're going to financially penalize you and use that to help pay for even more of the emergency insulin that people need.

Wurzer: Other countries like Canada limit how much prescription drug companies can charge, and that's why insulin is sometimes 10 times cheaper in Canada. That's why some Minnesotans are going up there, as you know. Why not just put a cap on drug prices?

Smith: I have another bill which I introduced a month or so ago — again, which would go after the overall challenges of drug price increases. And it's very important. There's lots of things that we could do, including importing — my bill would say let's import some of those lower-cost prescription medicines in from Canada, let's allow Medicare to negotiate directly with the big drug companies for lower prices. So those are all really important strategies. And what this bill that I'm just introducing with Senator Cramer from North Dakota, a Republican, is to address the emergencies that people have right now, not being able to afford the insulin that that they need literally to stay alive.

Wurzer: You know, there was an excellent article about this whole thing in the Washington Post a while back, and it did highlight the situation that occurred with Alec Smith here in Minnesota. It was very sad, of course, and part of that article talked about pharmacy benefits managers. Another cause of some higher insulin prices might be companies like Express Scripts. They negotiate lower prices for customers, but that makes the manufacturers raise prices for everybody else. So circling back to the penalties in your bill, would those penalties have any effect on the role that these pharmacy benefits managers play in prescription drug prices?

Smith: Well, we need so much more transparency in how these prices get set and what is sort of underneath the list price that gets charged to people like Lija Greenseid and Nicole Smith-Holt's son Alec when he couldn't afford the insulin that he needed. So we need to look underneath to understand what's driving these prices, both from the pharmacy benefit managers and the drug manufacturers. Actually, today we're going to be marking up a bill in the health committee that does some things with pharmacy benefit managers. But what happens is that both these different kinds of companies sort of point fingers at one another, saying it's all their fault, it's all their fault, and you know, I don't buy it. I think everybody should be held accountable.

Wurzer: Alright. Senator Smith, thank you for your time this morning.

Smith: Thanks so much.