Affordable Insulin
Recently, a patient shared with me that she wasn’t taking her insulin because when she went to fill the prescription the pharmacy told her it would be $900. And, she wasn’t checking her blood sugar because the pharmacy also wanted $100 for the test strips.
This is, of course, outrageous. Most people would find it cost-prohibitive to spend over $12,000 per year on insulin and test strips, not to mention the extra costs associated with other meds and medical visits.
For this reason, the American Diabetes Association has information on their website to help consumers navigate the very complicated US Healthcare system.
Here are some essential things to know if you use insulin:
Medicare is the US federal health insurance program for people who are 65 years old or older. You may also qualify for Medicare if you have end-stage renal disease (ESRD) or in certain cases of disability, even if you are under age 65.
Medicare Part B: as of July 1, 2023 insulin cost is capped at $35 per month
Medicare Part D: insulin included on the formulary is capped at $35 per month
Click here for FAQ about insulin caps with Medicare
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. Most Medicaid enrollees receive insulin for free or at a significantly reduced cost. However, each state makes its own determination about what’s covered.
Private/Commercial Insurance:
For state regulated insurance plans, more than half of all states + DC have co-pay caps on monthly insulin and supplies. Check your state’s insulin copay cap here.
If you do not have a state regulated plan or your state has not enacted a cap, some manufacturers offer co-pay assistance programs that can help reduce your out of pocket cost.
If you are uninsured, check with insulin manufacturers regarding their patient assistance programs that offer insulin at no or low cost to those who meet certain eligibility requirements. The American Diabetes Association has an updated list of manufacturers and their current assistance programs on their website: https://diabetes.org/tools-resources/affordable-insulin
I hope this information was useful. Please share it with a friend or loved one who may benefit. Insulin is a life saving drug and everyone who needs it should absolutely have access.
If you find yourself in a position to donate to the fight for affordable insulin, you can do so through the American Diabetes Association website.