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$35 monthly cap for insulin begins for Medicare recipients in 2023

The cap does not include Americans on private insurance.
Posted at 3:00 AM, Dec 15, 2022

ATLANTA, Ga. — The high cost of insulin has been highlighted for years. Over the last 20 years, prices have increased by around 600%.

Now, there is relief for many on the horizon for Americans with diabetes.


If you or anyone you know is diabetic, you understand what Althea Glover goes through.

Pricking fingers, checking numbers, she manages diabetes the best way she can.

"After a while, you get used to it," Glover said.

Across the country around 37 million Americans have diabetes. That's 11% of the country.

Not everyone needs insulin, but many do.

Althea lives at an assisted-living facility in Atlanta, Georgia. The state has one of the highest diabetes rates in the country.

She says she believes as many as 30 people she lives near, in the same building have diabetes.

Like so many Americans, Glover has a story of how the cost of managing the disease has impacted her life.

She says she has even had to ask her children to help her with money so she can buy insulin.

"He said mama what are we going to do," Glover said, speaking about one of her sons.


For seniors on Medicare Part D, the average monthly cost of insulin is $54.

For some, the cost is higher. For others, the cost is lower.

"That's a lot when you are on a supplemental income," Glover said.

However, come January 1st, that is changing with a new $35 monthly cap taking effect for those on Medicare Part D. The change was part of the Inflation Reduction Act signed into law this year.

3 million seniors are believed to be impacted.

Glover says where she lives the savings will be huge.

"A lot of them, just don't have the money," she said.

The news isn't entirely what diabetes advocates have been hoping for. In order to get the Inflation Reduction Act passed in the Senate, Democrats had to use something known as the reconciliation process, which requires fewer votes.

Capping insulin for those on Medicare qualified to pass that way. However, capping insulin for those with private insurance plans did not.

Some lawmakers remain apprehensive to tell private companies how much they can charge for something, fearing reduced profits will hinder the development of newer drugs.

As for Glover, she says this is a start. Diabetics have suffered too long, she said.

"We are going to have to work to get it down a bit more," Glover said.

The change for insulin isn't the only change for seniors taking effect on January 1st.

More vaccines will be offered for free for those on Medicare as well.

Currently, seniors must pay for many of them out-of-pocket.