How to Afford Your Insulin Medication

More than 37 million Americans have diabetes. No matter whether you have type 1 diabetes or type 2 diabetes, the costs of managing your condition can quickly add up. Finding ways to afford insulin is crucial to living with diabetes.

Costs can include diabetes supplies for home blood sugar monitoring, laboratory tests, office visits, emergency room evaluations, hospitalizations, and treatments like insulin.

The American Diabetes Association reports that people with diabetes account for 25% of all healthcare spending in the United States. On average, they spend approximately 2.3 times more on health care than people who do not have the condition.

These medical costs can leave people with diabetes in dire financial straits, especially considering the rising cost of insulin. This article will highlight resources for you to find more affordable insulin options and get the care you need.

How Much Does Insulin Cost?

Insulin costs have risen significantly since 2013, even for brands of insulin that are not new to the market. A 2021 report by the Senate Finance Committee found that the wholesale acquisition cost for many brand-name insulin products increased by as much as 33% to 72% depending on brand between 2013 and 2019.

GoodRx Health reported that the average retail price for insulin in October 2021 was $0.31 per unit. For perspective, the average person on insulin uses 62 units per day. That means someone could expect to pay approximately $19 per day or more than $570 per month for their insulin if they did not have insurance.

The actual costs will vary based on the type of insulin and the number of units prescribed per day. It will also depend on whether someone gets their insulin in vials (i.e., they have to draw the insulin up in syringes themselves) or in prepackaged insulin pens (i.e., the insulin is already loaded into an injectable pen).

Keep in mind that some people may require multiple insulin vials or pens each month to meet their needs.

Depending on the brand, insulin vials (10 milliliters of 100 units per milliliter) cost from $25 to several hundred dollars. A pen (3 milliliters of 100 units per milliliter) may come as a single pen but often comes in a multipack.

Because a pen holds less insulin than a vial of insulin, a greater number of pens than vials needs to be prescribed. When purchased in packages of five, the price per pen ranges from about $9 to over $200.

How to Afford Insulin

No one should have to forego the treatment they need because of cost. It is important to know where you can turn to get affordable insulin.

State-Run Programs

By July 2022, 22 states had set a cap on monthly insulin costs. Depending on the state, the cap either applies to all commercial health plans or only to state-run plans. In all of these states, the cap is set at $100 or less per month.

In addition to state insulin caps, several states offer State Pharmaceutical Assistance Programs (SPAPs) to help people manage their prescription drug costs. To find out if your state offers such a program and if you qualify, check the Medicare.gov pharmaceutical assistance plan finder page.

Medicaid 

Medicaid offers health coverage to people with low incomes, people who are disabled, and to the medically needy. Who and what is covered vary depending on whether your state expanded Medicaid under the Affordable Care Act. These programs cover diabetes care, and that includes insulin. You will need to check to see if you are eligible for Medicaid.

Medicare

Medicare is a federal program that provides health care to people 65 and older or for people with qualifying disabilities. Medicare is divided into different parts. Part B pays for insulin that is administered through an insulin pump. In that case, you will pay 20% of the cost of the insulin.

All other types of insulin require Part D coverage. Because private insurance companies run these plans, costs will depend on your plan’s deductible, coinsurance, and co-payment rates. The brand of insulin your healthcare provider prescribes must also be on your plan’s formulary (a list of prescription drugs preferred by your insurer).

The Inflation Reduction Act was passed in August 2022. Starting in 2023, it caps the cost of insulin to no more than $35 per month, regardless of the brand of insulin you use. The only catch is that the brand of insulin must be on your Part D formulary. 

If the cost of your medications is still outside of your reach, you may be eligible to apply for the Extra Help Part D Low Income Subsidy. The subsidy may offer significant discounts or pay for your medications outright, depending on your income level.

Pharmaceutical Patient Assistance Programs  

Pharmaceutical manufacturers may offer medication discounts to people older than 65, with disabilities, without insurance, or with low income. In some cases, they may even offer you medications for free.

You should contact the manufacturer directly to see if you qualify for one of their programs. You must fill out an application to show you meet income criteria. These programs may require you to reapply regularly to continue coverage.

Nonprofit Patient Assistance Programs 

Not all assistance programs are run by pharmaceutical companies. The following five charitable organizations also provide financial relief to decrease the burden on patients.

• GetInsulin.org
• Needy Meds
• RxAssist
• RxOutreach

Coupon Cards 

People who do not qualify for a Pharmaceutical Patient Assistance Program may still be able to take advantage of coupon cards offered by those pharmaceutical companies. These cards can be used by anyone and do not require an application. Keep in mind that they cannot be used together with your insurance.

Other online companies offer discount cards as well. These discounts may be higher or lower depending on what local or mail-order pharmacy you use. Here are five of the more popular online coupon cards available today.

• GoodRx
• RxGo
• RxSaver
• SingleCare
• WellRx

Disability Benefits 

The Americans with Disabilities Act defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities…; a record of such an impairment; or being regarded as having such an impairment.” Generally, having a disability can increase your overall healthcare costs and impact your quality of life.

People who have a disability may be able to receive income through Social Security Disability Insurance (SSDI). Alternatively, former railway workers may receive benefits through the Railroad Retirement Board.

To qualify for these benefits, your disability has to be severe and come with complications. A healthcare provider will need to confirm this and provide medical documentation that supports your disability application.

Although as many as 1 in 6 people who have a disability have diabetes, diabetes is not always the cause of their disability. For SSDI, having diabetes is not enough on its own to qualify someone for disability income. They need to meet eligibility criteria based on how their diabetes has affected other parts of the body.

This can include but is not limited to complications such as coronary artery disease (heart disease), diabetic nephropathy (kidney disease), diabetic neuropathy (nerve damage), and diabetic retinopathy (damage to blood vessels in the retina of the eye).

Not everyone will meet these requirements. With that in mind, the Social Security Administration also has procedures in place that will look at your age, education, work experience, and current functional limitations before making a final decision.

Disability status may be granted if it is determined that you could not be gainfully employed even if changes were made to accommodate you at work.

Other Ways to Afford Insulin

Insurance and drug discounts are not the only way to decrease your costs for diabetes treatment. Consider these other options as well.

Community Health Centers and Free Clinics

You may be able to seek care at a federally funded community health center or clinic. These clinics receive federal grants to treat underserved and vulnerable populations, including the uninsured and the underinsured. 

Alternatively, you may consider care through a local free clinic. These clinics may not receive federal funding, but they may be a helpful resource to get you free or low-cost care.

Choice of Insulin

Different brands of insulin may be more expensive than others. Changing to a less expensive insulin regimen may help keep costs down.

Whether you take rapid-acting, short-acting, intermediate-acting, long-acting, or ultra-long-acting insulin, you should discuss your options with your healthcare provider. They should prescribe an insulin regimen that works well for you, is affordable, easy to administer, and is covered by your insurance plan (if you are fortunate to have coverage). 

Lifestyle Choices

Decreasing how much insulin you need can rein in costs too. You can do this by incorporating the following lifestyle changes into your routine to get your blood sugars under better control:

• Healthy eating: Decreasing your carbohydrate intake can help you better manage your blood sugar levels. That does not mean you have to go on a strict low-carb diet. Diets that are rich in whole grains, nuts, seeds, legumes, fruits, and vegetables and diets that are low in added sugars, saturated fats, red meat, and processed meat are also beneficial.
• Physical activity: Only 53.3% of American adults get the recommended amount of aerobic exercise. Not only does exercise help decrease fasting blood sugars, but it also makes the body more sensitive to insulin. That means you do not need to take as much insulin to get the same benefit.
• Weight management: As of 2020, 41.9% of Americans have obesity. Studies show that losing even 5% of body weight can significantly improve blood sugars and decrease the number of medications needed to treat the condition.

If you find making these changes on your own challenging, you may consider participating in a Diabetes Self-Management Training Program like the one offered to Medicare beneficiaries. In the first year, the program provides 10 hours of one-on-one and nine hours of group training. Each year after that you can get two hours of additional training.

Summary

Diabetes is one of the most expensive chronic medical conditions to manage today. It is made all the more challenging by the rising cost of insulin cost.

There are a number of strategies you can use to decrease how much you pay out of pocket. Talking with your healthcare provider about less expensive insulin options is a start. By eating healthy, exercising regularly, and managing your weight, you may get better control of your blood sugar so you could potentially need less insulin.

To save on insulin costs, you could turn to a State Patient Assistance Program, Pharmaceutical Assistance Program, charitable organization, or use drug coupons and discount cards. If you are on Medicare, you may also qualify for the Part D Low Income Subsidy known as Extra Help.

A Word From Verywell

No one should be priced out of diabetes care. Rationing insulin or not purchasing insulin at all can be dangerous and increases the risk for long-term health complications. Thankfully, there are ways you may be able to decrease the cost of your insulin. Be proactive and seek out one of the options discussed above.