Minnesota announced a third and final settlement Monday in its price-fixing lawsuit against the so-called Big Three manufacturers of insulin, expanding low-cost access to the diabetes drug.

Novo Nordisk agreed to cap insulin prices for the next five years so that Minnesotans won't have to pay more than $35 for monthly prescriptions. Eli Lilly and Sanofi reached similar settlements over the past year to resolve their parts of this lawsuit.

"No matter what insulin products you use in Minnesota, you no longer have to choose between affording your life and affording to live," said Minnesota Attorney General Keith Ellison. Annual insulin expenses had ballooned to $6,000 per year for some Minnesotans, he added, but now they will be less than $600.

Minnesota was the first state in 2018 to sue manufacturers, accusing them of grossly inflating prices on insulin and making the essential drug unaffordable. Joining Ellison on Monday was Nicole Smith-Holt, who became a leading voice in the fight against high insulin prices after her 26-year-old son rationed medication he couldn't afford and died in 2017.

"There is a long list of people who have died from complications or from rationing and Minnesota has stood boldly against Big Pharma and said it's unacceptable," she said.

Affordable medication is increasingly important in a state where one in 10 adults has diabetes, a disease in which the body can't produce insulin, or produces too little to regulate blood sugar levels. The percent of Minnesotans with diabetes has nearly doubled over the past 20 years in lockstep with the state's rising rate of obesity.

The practical implication of Monday's announcement was somewhat muted. Novo produces about half of the insulin for the U.S. diabetes market, and it had already announced in 2023 that it was slashing prices on the drug.

"These settlements are just another example of Novo Nordisk's commitment to ensuring affordable access to insulins by reducing the burden of out-of-pocket costs, helping transform the complex pricing system, and fostering better pricing predictability," said a Novo Nordisk spokesperson.

Ellison said the settlement is important because it is binding and enforceable, where before drug companies could change voluntary discounts or price reductions at any time.

Drug companies have offered discounts in the past, but sometimes on insulin products that end up being hard to find or unavailable at major pharmacies, said Quinn Nystrom, a board member for the American Diabetes Association of Minnesota. "That is why something like this is so critical, because no matter if they are doing a PR stunt or whatever they would like to call it, we now have this secure thing for five years."

Minnesota has taken legislative steps to reduce costs, including a 2020 law in memory of Alec Smith that made a month of emergency insulin available for $35. A new law also took effect Jan. 1, limiting monthly copays to $50 for diabetes supplies such as needles and test strips.

Ellison said the legal agreement buys time for Minnesota lawmakers to create more permanent solutions to prescription drug affordability.