Insulin Price Cap at $35: Uses, Benefits, and Side Effects

The $35 monthly insulin price cap is one of the most significant diabetes affordability changes in decades. Beginning in January 2023, the Inflation Reduction Act capped out-of-pocket insulin costs at $35 per month for Medicare Part D beneficiaries — and shortly after, the three major insulin manufacturers extended similar pricing voluntarily to commercially insured and uninsured patients nationwide. State laws have added commercial coverage requirements. This guide explains exactly who benefits, where the loopholes are, and how to claim the cap if it applies to you.

The Federal Cap — What the Inflation Reduction Act Did

• Effective date: January 1, 2023, for Medicare Part D; July 1, 2023, for Medicare Part B (pump) insulin
• What it covers: Out-of-pocket cost per covered insulin per 30-day supply
• Cap amount: $35 per insulin per month
• What it does not cover: Commercial insurance, employer-sponsored plans, ACA Marketplace, uninsured (not federally)
• Applies throughout: Deductible phase, initial coverage, catastrophic coverage — all phases
• Per-product: If you use a long-acting plus a short-acting insulin, each is capped at $35 separately

Who Gets $35 Insulin in 2026

Manufacturer Programs That Extend $35 Pricing

Eli Lilly — Insulin Value Program

• $35 per monthly prescription for any Lilly insulin
• Includes Humalog, Humulin, Basaglar, Lyumjev, Insulin Lispro authorized generic, Insulin Aspart authorized generic
• Available to anyone with commercial insurance or no insurance — not for Medicare or Medicaid
• Apply at insulinaffordability.com or download card at pharmacy
• No income limit; no application required for many patients

Novo Nordisk — My$99Insulin and NovoCare Savings Card

• My$99Insulin: $99 per month for up to 3 vials or 2 packs of pens of any combination of NovoLog, Novolin, Levemir, or Tresiba
• NovoCare Savings Card: as low as $35 per month for commercial insurance
• Not for Medicare or Medicaid
• Order direct from Novo Nordisk for My$99Insulin or use card at pharmacy

Sanofi — Insulins Valyou Program

• $35 per 30-day supply (1 vial or 1 box of pens) for uninsured patients
• $99 for up to 10 vials or 10 boxes of pens
• Includes Lantus, Toujeo, Apidra, Admelog
• Sanofi Savings Card: as low as $0 per month for commercial insurance Lantus/Toujeo
• Not for Medicare or Medicaid

State Laws Capping Commercial Plans

State caps do not apply to self-funded employer plans (regulated under federal ERISA), Medicare, or Medicaid. Always confirm with your state insurance department for current rules.

How to Claim Your $35 Insulin at the Pharmacy

1. Confirm your insulin is on your insurance formulary (call plan or check member portal)
2. If on Medicare: present your Part D card — cap is automatic
3. If on commercial insurance: present manufacturer savings card alongside insurance card
4. If uninsured: enroll in manufacturer program (Lilly, Novo Nordisk, or Sanofi) and present card
5. If on state-capped commercial plan: cap applies automatically — flag to pharmacist if charged more
6. If charged more than $35: ask the pharmacist to rerun the claim; show manufacturer or state documentation
7. If still incorrect: call your insurance plan and request an override

Special Cases

Concentrated Insulins (U-200, U-300, U-500)

Toujeo (insulin glargine U-300), Humalog U-200, Humulin R U-500, and Tresiba U-200 are all eligible for the $35 cap under Medicare Part D as long as they are on the plan formulary. Manufacturer programs typically include them too.

Combination Products

Soliqua (insulin glargine + lixisenatide) and Xultophy (insulin degludec + liraglutide) are technically insulin-containing combination drugs. Whether they qualify for the Medicare $35 cap depends on Part D plan classification — some count them as insulin, others as combination products. Check plan documentation.

Insulin Biosimilars

Semglee (insulin glargine biosimilar), Rezvoglar (insulin glargine biosimilar), and Admelog (insulin lispro biosimilar) are typically priced below $35 anyway and qualify for the cap if on formulary.

Pump Insulin

Insulin filled in pump reservoirs is covered under Medicare Part B as durable medical equipment supply and capped at $35 per month under parallel Inflation Reduction Act rules.

What If Your Insulin Is Not Covered?

1. Ask prescriber to switch to a formulary-listed insulin of the same class
2. If no good alternative: appeal for formulary exception with documented clinical need
3. During Open Enrollment: switch to a Part D or commercial plan that covers your insulin
4. Use a manufacturer program in the meantime (Lilly $35, Novo Nordisk $99, Sanofi $35)
5. For Medicare patients: state pharmaceutical assistance programs sometimes fill gaps

Common Pitfalls

• Assuming the federal cap applies to commercial insurance — it does not, unless your state has its own law
• Letting a 28-day insulin pack be billed as 28-day not 30-day — clarify with pharmacist for correct cap math
• Filling a 90-day supply and being charged $105 instead of $35 — federal cap is per 30 days; 90-day fills should be $105 maximum
• Missing manufacturer savings card enrollment for commercial plan patients — adds an extra step but worth it
• Trying to stack Medicare with a manufacturer card — not allowed; Medicare $35 cap is your benefit
• Switching insulins for non-medical reasons — confusion at the pharmacy; coordinate with prescriber

What the Cap Means for Total Diabetes Costs

Capping insulin at $35 saves typical Medicare patients on multiple insulins $500 to $3,000 per year. Combined with the 2025 $2,000 annual Part D out-of-pocket cap, total diabetes drug costs are now predictable for the first time in decades. For uninsured patients, manufacturer programs translate to similar savings. The cap does not lower the cost of GLP-1s, SGLT2 inhibitors, or DPP-4 inhibitors — those are separate (see manufacturer assistance).

Outlook for 2026 and Beyond

The federal $35 cap is permanent law unless Congress repeals it. Manufacturer programs are voluntary and could change — Lilly, Novo Nordisk, and Sanofi have maintained them through 2026 without reduction. Insulin biosimilars continue to enter the market, putting downward pressure on prices even outside the cap. Several additional states are considering commercial insurance caps. Talk to your doctor and pharmacist annually to make sure you are paying no more than the lowest available program offers.

Related Reading

See Medicare diabetes coverage, manufacturer assistance programs, Walmart $4 diabetes list, ACA Marketplace and diabetes, and our treatment hub.

The Bottom Line

The $35 monthly insulin price cap is real for Medicare beneficiaries — guaranteed by federal law since January 2023 — and effectively available to most other patients through manufacturer programs and state laws. Eli Lilly’s Insulin Value Program, Novo Nordisk’s My$99Insulin, and Sanofi’s Valyou Program extend $35 to $99 monthly pricing to commercially insured and uninsured patients without income limits. State-level caps protect commercial plan members in Colorado, Illinois, New Mexico, Washington, New York, California, and a growing list of others. Federal law does not require commercial or self-funded employer plans to honor the cap, but most patients can stack manufacturer programs to reach the same number. Confirm your insulin is on your plan formulary, enroll in the relevant manufacturer program, and ask your pharmacist to flag any charges over $35 per 30-day supply. No one should be rationing insulin in 2026 — talk to your doctor and pharmacist about which combination of programs applies to you.