Medicare Part D Insulin Cap — $35 insulin cap
Under the Inflation Reduction Act, Medicare caps insulin at $35 per month per covered product across Part D and Medicare Advantage drug plans.
Official source: medicare.gov
The Medicare Part D insulin cap limits what you pay out of pocket for insulin to $35 per month for each covered insulin product. The cap applies no matter the drug's list price and no matter where you are in your plan's coverage phases.
This rule came from the Inflation Reduction Act and now applies across stand-alone Part D plans, Medicare Advantage prescription drug plans, and insulin used with a traditional pump covered under Part B.
The Part D deductible does not apply to insulin. Even early in the year, you pay no more than $35 per 30-day supply per covered insulin from day one.
Insulin sits inside a broader 2026 Part D protection: a $2,100 annual out-of-pocket cap on all covered drugs. After you spend $2,100 on covered medications, your plan pays 100% of additional drug costs for the rest of the year.
If you are still rationing insulin because of cost, you do not have to. Call your Part D plan to confirm which insulin products on their formulary are subject to the $35 cap and whether the Medicare Prescription Payment Plan can spread your costs across the year.
In real life
- A retiree takes long-acting and rapid-acting insulin. Their Part D plan charges $35 per 30-day supply for each product. Total insulin cost is $70 per month, with no deductible to meet first.
Also known as
Frequently asked questions about Medicare Part D Insulin Cap
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Source: medicare.gov