All tools · Prescription Price Cutter

How Much Does Insulin Cost With Medicare?

Use the free tool — Prescription Price Cutter

The Medicare Insulin Cap

If you have Medicare, insulin covered under Part D or Part B is capped at $35 a month. Medicare Part D also caps what you pay for covered drugs overall at $2,000 a year. Confirm exactly how this applies to your plan and your specific insulin with your plan or pharmacist. Source: Medicare.gov — Part D costs.

If Money Is Tight: Extra Help

Extra Help is a Medicare program that pays most Part D drug costs for people with limited income and resources. It is free to apply, through Social Security. Eligibility depends on income and resource limits listed on the Social Security page below — check whether you qualify. Source: SSA — Extra Help with Medicare drug costs.

No Medicare, or a Commercial Plan?

The $35 Medicare cap applies to Medicare Part D and Part B insulin. If you have an employer plan or no insurance, the cap does not automatically apply. Ask your pharmacist or the insulin manufacturer — Lilly, Novo Nordisk, and Sanofi have each published their own $35 assistance programs — whether one applies to you. You can also search manufacturer and charity assistance programs by drug name. Source: Medicine Assistance Tool · NeedyMeds. Prices differ by pharmacy — ask for the cash price and the discount-card price, as well as the insurance price, and compare. A discount card usually cannot be combined with insurance on the same fill, and that fill may not count toward your deductible.

Comparing Plans and Formularies

Insulins sit on a "tier" in your Part D plan's formulary, which affects your cost. If your insulin isn't covered well, you or your prescriber can ask the plan for a tiering exception or a formulary exception — this usually needs a letter from your prescriber. During Medicare's Open Enrollment, October 15 to December 7, you can compare plans on Medicare.gov's Plan Finder using your actual drug list to see which plan costs less for your insulin. Florida's free, unbiased Medicare counseling service, SHINE, can help with all of this at 1-800-963-5337. Source: Florida SHINE.

If You're Skipping Doses Because of Cost

Tell your prescriber and pharmacist today. They can often help the same day, including with samples, program applications, or a formulary exception. Never stop, skip, split, or change an insulin dose without talking to your prescriber first — this guide can be wrong.

What to Do Next

Prescription Price Cutter is a free tool that reads your own drug, dose, what you pay, and your coverage, and shows the cheaper paths that apply to you, in order — no account, nothing stored. It is not medical, pharmacy, or insurance advice. Always confirm any program or price with your pharmacist, your prescriber, or SHINE before making a change.

Prescription Price Cutter explains ways to lower prescription costs in plain language from official sources; it can be wrong, and it is not medical, pharmacy or insurance advice. It never states a drug price. Talk to your prescriber before any change. Nothing you type is stored.