Let's set the stage. The $35 insulin cap came from the Inflation Reduction Act. It started for Part D on January 1, 2023, and for insulin used with a traditional pump under Part B on July 1, 2023, according to CMS. It is still in place for 2027, and it applies in stand-alone Part D plans and in Medicare Advantage plans with drug coverage.
How the insulin cap works
| Situation | What you pay |
|---|---|
| One month supply of a covered insulin, Part D | No more than $35 per product |
| Three month supply | No more than $35 per month, generally $105 |
| Before you meet your drug deductible | Still no more than $35, insulin skips the deductible |
| Insulin used in a Part B covered pump | No more than $35 per month, no Part B deductible |
| With Extra Help | The $35 limit still applies, and Extra Help may lower it further |
The fine print that trips people up
- It is per product. If you use a long acting and a rapid acting insulin, each one is capped at $35 a month, so you could pay up to $70.
- It has to be covered. The cap applies to insulin products on your plan's formulary. If your insulin is not covered, the cap does not help. Check the formulary before you enroll.
- Supplies are separate. Needles, syringes and pen needles are not insulin, and your plan's normal cost sharing applies to them.
- GLP-1 drugs are not insulin. CMS has said non insulin injectables such as GLP-1 drugs are not covered by the $35 insulin cap. Ozempic is priced under your plan's normal drug tiers. See Does Medicare cover Ozempic?
How insulin fits with the 2027 Part D cap
Your insulin payments count toward the 2027 Part D out-of-pocket limit of $2,400. If you also take other brand drugs, the insulin cap and the yearly cap work together to limit your total. See the 2027 Part D cap.
What about negotiated insulin prices?
In 2027, no insulin has a Medicare negotiated price. NovoLog and Fiasp were in the first round of negotiation, but CMS removed them from the program effective January 1, 2027, under its rule that a drug leaves once a generic or biosimilar version is on the market. Their negotiated price ends December 31, 2026. For comparison, it was $119 for a 30 day supply in 2026, versus a 2023 list price of $495, per CMS. None of this changes your $35 cap, which comes from a separate part of the law and stays in place for 2027.
Choosing a plan when you use insulin
- List each insulin by brand name and form (vial, pen or pump).
- Confirm each one is on the 2027 formulary of the plans you are comparing. 2027 formularies are being added to our data now.
- Check your pharmacy is preferred in network, so your other drugs are priced well too.
- Price your full drug list, not just insulin.
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Frequently asked questions
Does the $35 insulin cap apply to Medicare Advantage plans?
Yes, if the Medicare Advantage plan includes Part D drug coverage and the insulin is on its formulary. Insulin used with a Part B covered pump is also capped at $35 a month.
Is insulin subject to the Part D deductible?
No. Medicare.gov says you do not have to pay a deductible for insulin, so the $35 cap applies from your first fill of the year.
Is Ozempic covered by the $35 insulin cap?
No. Ozempic is a GLP-1 drug, not insulin, and CMS has said the $35 cap does not apply to non insulin injectables. Its cost depends on your plan's tier and deductible.
How much is a 90 day supply of insulin with Medicare?
Generally no more than $105, because the cap is $35 for each month's supply of each covered insulin product.
Sources
- Medicare.gov: Insulin coverage
- CMS fact sheet: Anniversary of the Inflation Reduction Act, update on CMS implementation
- CMS: Frequently asked questions about Medicare insulin cost-sharing changes
- CMS fact sheet: Negotiated prices for initial price applicability year 2026
- CMS: Selected Drug List and Negotiated Prices data file (ZIP, September 21, 2026)
- CMS: Selected drugs and negotiated prices
Updated October 26, 2026 by the Everything Senior Insurance Data Desk.