New Research Shows Need for Better Insulin Access Beyond Medicare

Research published this month shows that over one million adults rationed insulin doses in the past year due to the drug’s high costs. These cutbacks took various forms, including delaying purchase, skimping on doses, or skipping the medication altogether.

In the United States, insulin prices far outstrip costs in other countries, often by five to ten times. This puts life-saving insulin out of reach for many. According to the research, uninsured people were the most likely to ration, at 29.2%. Those with private insurance were second, at 18.8%.

Despite this clear need, Congressional attempts to cap insulin costs for people with private coverage were stripped out of the Inflation Reduction Act (IRA) by Senate Republicans, who challenged their inclusion under budget reconciliation rules.

But the IRA will help insulin users with Medicare. In January, the IRA will limit Part D enrollee insulin costs to $35 per prescription per month for covered products. On July 1, this cap goes into effect for insulin used with a pump under Part B.

Medicare open enrollment is ongoing, and we urge insulin users to determine whether their insulin is on their drug plan’s formulary and therefore capped before they sign up or renew. Importantly, Medicare Plan Finder will not be updated to reflect the IRA’s insulin cap until next year. To avoid inaccurate pricing in the interim, we suggest people use the tool to compare plans without insulin first, then run a search adding in any insulin prescriptions to make sure they are covered.

If you need assistance this fall, connect with your local State Health Insurance Assistance Program (SHIP) for unbiased, one-on-one counseling; contact Medicare online at https://www.medicare.gov/ or by calling 1-800-MEDICARE; or call the Medicare Rights Center’s national helpline at 800-333-4114.

Read more about insulin rationing research.

Read more about the IRA.

Read more about Medicare open enrollment.