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The $35 monthly insulin cap

Part D plans must cap your cost for covered insulin at $35 per month or less — no deductible required.

$35
Max monthly insulin cost
$0
Deductible for insulin

How the cap works

If you have Part D coverage, your out-of-pocket cost for a one-month supply of each covered insulin product is capped at $35 or less. This applies in all phases of Part D coverage — including the deductible phase.

For 2026, the cap is set at the lower of $35 or 25% of the Maximum Fair Price for the insulin product.

Key facts

  • The cap applies to all Part D plans — both standalone PDPs and Medicare Advantage drug plans
  • You don't need to meet your deductible before the cap kicks in
  • The cap applies per one-month supply of each covered insulin product
  • Not all insulin products may be on your plan's formulary — check before enrolling
  • This benefit was established by the Inflation Reduction Act, starting in 2023

Check your plan's insulin formulary

While all Part D plans must offer the $35 cap, the specific insulin products covered vary by plan. Make sure your insulin is on the formulary of any plan you're considering.