Insulin Cost and Affordability

Medical professionals sitting with patients

Insulin

Insulin Cost and Affordability

March 16, 2023: Sanofi announces insulin price cuts.

“The American Diabetes Association (ADA) is the leading voice advocating for insulin affordability and is working to ensure that all people with diabetes have access to the care they need. The ADA has led the charge to enact cost-sharing limits on insulin in 22 states and D.C., and the first-ever federal copay cap in Medicare. We are encouraged that all of the major manufacturers have taken steps to make insulin more affordable, but the fight is not over. We will continue advocating for efforts in Congress and states across the country to ensure insulin is affordable to everyone with diabetes who relies on it to survive.”- Lisa Murdock, ADA Chief Advocacy Officer

March 14, 2023: Novo Nordisk announces insulin price reduction.

“The American Diabetes Association® (ADA) is the leading voice advocating for insulin affordability and is working to ensure that all people with diabetes have access to the care they need. The ADA has led the charge to enact cost-sharing limits on insulin in 22 states and D.C., and now the first-ever federal copay cap in Medicare. We are pleased that more manufacturers are continuing to take steps to make insulin more affordable, and we hope others follow suit. ADA will keep working to make sure drug rebates are not inflating costs for patients at the pharmacy counter, and we will continue to support efforts to provide affordable insulin to everyone with diabetes who relies on it to survive.” - Lisa Murdock, ADA Chief Advocacy Officer

March 1, 2023: Lilly announces cost-sharing limits on insulin.


“The American Diabetes Association (ADA) is the leading voice advocating for insulin affordability and is working to ensure that all people with diabetes have access to the care they need. We applaud Eli Lilly for taking the important step to limit cost-sharing for its insulin, and we encourage other insulin manufacturers to do the same. While we have been able to help achieve significant progress on the issue of insulin affordability, including Medicare’s new out-of-pocket cost cap on insulin, state copay caps, and patient assistance developments from insulin manufacturers, we know that our work is not done. We will work to ensure that Eli Lilly’s patient assistance program is benefiting patients as intended and continue the fight so that everyone who needs insulin has access.”  — Charles “Chuck” Henderson, CEO of the American Diabetes Association

Join Us in the Fight for Affordable Insulin!

Your support and voice matter in making insulin more affordable. There are two ways to join us:
Become an Advocate
Donate to the ADA

There have been significant recent developments including Medicare’s new monthly and annual out-of-pocket caps on insulin and prescription drugs, state enacting co-pay caps on insulin, other policy reforms, and patient assistance programs through insulin manufacturers.

We know you may have questions about what this means for you. Don’t worry, we’ve got you covered. Below is information about out-of-pocket caps for insulin and how you can take advantage of the new cost-sharing limits based on the type of health insurance coverage you have:

MEDICARE

65 or older

Medicare is the federal health insurance program for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS). For information about Medicare eligibility, please visit Medicare.gov.
Medicare.gov

Insulin covered under Medicare Part D

As a result of the Senior Savings Pilot and subsequently the Inflation Reduction Act of 2022, Medicare Part D enrollees monthly cost sharing for insulin is capped at $35. A covered insulin product is one that is included on a Medicare Part D plan formulary.

Insulin covered under Medicare Part B

Beginning July 1, 2023, insulin covered under Medicare Part B including insulin delivered through a traditional pump that is covered under the durable medical equipment benefit will also be capped at $35 per month.

Insulin out-of-pocket cost-sharing

For more information about recent changes to insulin out-of-pocket cost-sharing under Medicare, see these frequently asked questions from the U.S. Centers for Medicare and Medicaid Services (CMS).
Frequently Asked Questions (Download PDF)

MEDICAID

Medicaid is a joint state and federally funded health insurance program that provides health coverage to certain lower income individuals and families, including children, parents, people who are pregnant, elderly people, and people with disabilities. For information about Medicaid eligibility, please visit Medicaid.gov.
Medicaid
Most Medicaid enrollees receive insulin for free or at a significantly reduced cost. However, each state makes its own determination about which diabetes medications and supplies are covered through its Medicaid program. For more information about what medications and supplies are covered in your state, please contact your state Medicaid agency.
Medicaid agency

PRIVATE/COMMERCIAL INSURANCE

State regulated health insurance plans

Twenty-two states and the District of Columbia have enacted legislation that caps co-payments on monthly insulin and some also limit cost sharing for supplies. There are additional states considering legislation to cap monthly insulin costs, so check back regularly.
State Insulin Copay Caps

Other private insurance coverage

Check with your insurance company to understand which insulins are covered and the expected co-pay for each. Some manufacturers offer co-pay assistance programs to help reduce your out-of-pocket cost. Visit InsulinHelp.org to see what programs are available.
InsulinHelp.org

UNINSURED

Patient assistance programs

Insulin manufacturers provide insulin at no cost through their patient assistance programs to people who are uninsured and meet income eligibility requirements. For more information about manufacturer patient assistance programs, visit InsulinHelp.org.
InsulinHelp.org

Join Us in the Fight for Affordable Insulin!

Your support and voice matter in making insulin more affordable. There are two ways to join us:
Become an Advocate
Donate to the ADA