The Inflation Reduction Act (IRA) capped out-of-pocket costs for insulin medications for people with Medicare. Coinsurances and copays for insulin covered under Part D have been limited to $35 a month for a month’s supply of each medication since January 1. Starting Saturday, July 1, beneficiaries whose insulin is covered under Part B will also enjoy these protections.

Medicare covers insulin and insulin containing products in two ways depending on how the medicine is administered.  Insulin used in conjunction with a covered infusion pump is covered through the Durable Medical Equipment (DME) benefit under Part B. All other insulin is covered under Part D, including insulin that people inject using syringes, fillable or pre-filled pens, or non-durable patch pumps.

A recent report from the U.S. Department of Health and Human Services (HHS) indicates Medicare beneficiaries would have saved $734 million in Part D costs and $27 million in Part B costs if the IRA’s insulin cap had been in effect in 2020. Specifically, the report notes that around 31,000 people with Part B would have saved money if the IRA’s provisions were in effect in 2020, savings of about $866 per beneficiary. Prior to the IRA’s changes, the national average out-of-pocket cost for a month’s supply of insulin for people with Medicare or private insurance was about $63 per fill. 

Learn more about Medicare coverage of diabetes screenings and supplies.

For more on Medicare changes in 2023, read and bookmark this Medicare Interactive resource.