I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet?

Question

Angela Ellington · Accepted Answer

It's a good idea to review your Part D coverage every year with a Licensed Broker for this reason. Formulary covered insulins are capped at $35, but it's possible that the brand that you use is no longer on your Part D formulary. The Inflation Reduction Act created a $2000 catastrophic limit in 2025, but if your drug is not on the formulary, it won't count toward the calculation, either.

Answered by Angela Ellington on April 14, 2025

Agent Licensed in CA, AZ, FL & 9 other states

Answered by Angela Ellington Medicare Insurance Agent

Gary Church · Answer

The time to review your drug plan is each year during AEP, which starts on October 15 and ends on December 7. Insulin was capped at $35.00, and that is what you should be paying.

Steve and Sue Brauer · Answer

Something does not sound right... insulin costs are capped at $35 each month. I would check with your broker if you were being charged more than that.

Terri Reagin · Answer

Insulin drugs treating diabetes are not created equally. There are insulins that have a year-round low co-pay, but there are some insulins, like Ozempic or Mounjaro for example, that do not fall under the regular insulin category. They can definitely have an increase in cost. And no, there was no magical fix with the Inflation Reduction Act that makes all medications that treat diabetes inexpensive. There are still some medications that are pretty expensive for diabetes, unfortunately.

So, hope this helps! If you have any questions, I would contact a local agent who can guide you to what your options are to lower your cost. Or you can always apply for extra help through Social Security and potentially get prescription drug assistance.

So, hope this helps! If you have any questions, I would contact a local agent who can guide you to what your options are to lower your cost. Or you can always apply for extra help through Social Security and potentially get prescription drug assistance.

Tony Capraro III · Answer

I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet? Good question. Those Medicare Part D drug plans change every year for what they cover and how much they cover. So what I do at my State Farm agency here on Kelly Street in Manchester, New Hampshire, is bring clients in every year. We take a look at all the myriad of Part D plans that are available out there to make sure that their prescriptions are covered and at a reasonable cost. This way, we save a lot of time, effort, and mistakes. I'd be glad to help you with that. Again, those Plan D plans change every year, so you have to be cognizant of that and what prescriptions you're on. I'd be glad to help you.

Lynn C Shurtleff · Answer

Insulin is still capped at $35. The carrier for your part D or Medicare Advantage may no longer cover that particular insulin which in that case you would be responsible for the entire cost. Check with your carrier and review your options for 2026 as well. There may be a plan that will offer lower costs for that insulin.

Answered by Lynn C Shurtleff on November 14, 2025

Broker Licensed in TN, AR, CO & 6 other states

Answered by Lynn C Shurtleff Medicare Insurance Agent

Shelly Hefley · Answer

Last year there were significant changes in the prescription drug plan guidelines, and every year formularies change. It’s very important to speak to a licensed local agent/broker who can help you choose the right plan for you for each year.

Answered by Shelly Hefley on September 16, 2025

Broker Licensed in IN, AL, IL, KY & TN

Answered by Shelly Hefley Medicare Insurance Agent

Michael Denniston · Answer

Your insulin price should be no more than 35.00 in 2025 on all Medicare Drug plans offered. If your insulin is a brand name instead of equivalent generic preferred you may pay more than the 35.00, without prior authorization. Your maximum out of pocket for 2025 is 2000 on all Medicare PDP plans. The affordable care act did not cure all issues with Medicare PDP (prescription drug plans), this is my opinion and my personal experience as well. Michaels Insurance Solutions.

Answered by Michael Denniston on June 28, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston Medicare Insurance Agent

Sandra Teel · Answer

In January 2023, insulin was capped at $35.00 for a 1-month supply for Part D and B prescriptions. You should pay no more than that for a covered insulin. If you insulin shot up in price, it could be that your insurance company doesn't cover that insulin any longer and you might have to change types of insulin or change your prescription drug company.

Answered by Sandra Teel on March 2, 2026

Broker Licensed in WV, AZ, CA & 13 other states

Answered by Sandra Teel Medicare Insurance Agent

Mark Zaruba · Answer

Although the cost of insulin goes up annually just as all medication, your cost while on Medicare is $35/mo and the maximum annual cost for all medication costs is $2100 for 2026.

Sandra (Sandy) Steffy · Answer

That is incredibly frustrating, and you're right to be confused. The key is that the $35 cap on insulin under the Inflation Reduction Act (IRA) only applies to people enrolled in Medicare (Part D and Part B). If you have private insurance or are uninsured, you are not covered by the federal cap, and your costs may still rise based on your specific plan's formulary or deductible changes.  
​However, major manufacturers like Eli Lilly, Novo Nordisk, and Sanofi have since voluntarily capped their insulin copays at $35 for most commercially insured and uninsured individuals—so you may still have options to lower the cost by checking those manufacturer programs.

Jamie Goble · Answer

Medicare Caps the cost of a one - moth supply of covered insulin at no more than $35 for both part B and part D plans.
You do not have to pay the deductible for insulin that are covered under part D. Hope that helps.

Christopher Palazzini · Answer

You should be shopping out a Part D plan every single year. No matter what. Whether your meds changed or not. Part D plans change their formularies every year. Inflation reduction act will not help you if the RX is not on the formulary list. Co pays and annual deductibles can apply as well.

Answered by Christopher Palazzini on March 30, 2025

Broker Licensed in FL, CA, CO & 7 other states

Answered by Christopher Palazzini Medicare Insurance Agent

Melanie Baxter Black · Answer

The Inflation Reduction Act ensured that Medicare beneficiary would an annual $2,000 maximum out-of-pocket expense. For purposes of the payment plan, the year begins on January 1st of each year and ends on December 31st of each year. The Inflation Reduction Act provides an optional payment plan that would allow you to get your medications without payment at the pharmacy at the time of pickup. You would receive a monthly billing for all of your copays for payment up to the $2,000 annual maximum out-of-pocket expense. You have until December 31st of each year to pay it off. Once you opt into the payment plan, you cannot opt out for that year -AND- ALL of your prescriptions are included in the payment plan. You may not pick and choose which presctiptions you want on the payment. Prices of your insulin are decided on by the Part D presctiption drug plan carriers. The Inflaction Reduction Act does not affect individual drug pricing.

Answered by Melanie Baxter Black on May 19, 2025

Agent Licensed in TX

Answered by Melanie Baxter Black Medicare Insurance Agent

Jonathan Paddon · Answer

It is true that the Inflation Reduction Act caps the cost of covered insulins at $35 per month for Medicare part D members. If your insulin shot up in price, then it is possible that your plan dropped your particular brand of insulin from its list of covered medications (called the formulary). As it is likely too late to change your plan until the fall open enrollment period, you basically have two options. You can talk to your doctor about finding an alternative insulin on your plan's formulary that would be similar to the one you are currently taking. Alternatively, you can submit a request to your plan to make an exception for your current insulin to be covered. Your plan will consider your request based on your doctor's documentation of why you need that particular medication.

Answered by Jonathan Paddon on August 25, 2025

Agent Licensed in TN, AL, FL, GA, IL & MS

Answered by Jonathan Paddon Medicare Insurance Agent

Michelle Simonds · Answer

Yes, the IRA capped out of pocket costs for insulin at $35/month. However, this cap only applies to insulin products that are covered under your specific Part D plan's formulary. If your formulary has changed, you might be paying more. I can assist you in reviewing your options and finding a plan that meets your needs.

Answered by Michelle Simonds on May 5, 2025

Agent Licensed in PA, FL & NY

Answered by Michelle Simonds Medicare Insurance Agent

Tracy Briley · Answer

The Inflation Reduction Act has nothing to do with Medicare Part D. All pricing, rules and regulations for Medicare, including Part D and Medicare Advantage plans, are controlled by CMS, The Centers for Medicare and Medicaid Services, which is part of Health and Human Services. 
Always check your plans every year, as plans change every year.

Steven Bleicher · Answer

Someone has not brought you up to speed. You always have choices. First of all, please do not forget to read your "ANOC" or Annual Notice of Change which is mailed to you every October which compares the current year costs to the following one. My guess is that you are paying much more premium per month since you don't have the means of checking other plans in your particular State. What is elusive is that a Part D plan can delete a drug that you take and you'd not know that this has occurred. Therefore, it is ESSENTIAL for you to call your company's customer service department, asking for a supervisor and determine which of your drugs are not a part of their drug formulary for the next year. 

Insulin Price Cap: If you use insulin, Medicare capped monthly insulin costs at $35.00 apiece which began in 2023. Don't let a drug store clerk tell you that it is not $35.00 since they know nothing about Medicare and the Inflation Reduction Act. Furthermore, No-Cost Adult Vaccines: since 2023, vaccines under Medicare Part D are available at no cost to adults which can keep you protected without unexpected expenses. However, we cannot predict if insulin may be on the rise in the future due to our global economy. 

However, NEVER simply retain the original Part D plan that you started with, since the volatility of pharmaceuticals is rampant at this time. Always use Medicare.gov and investigate if from one year to the next, not just insulin but all of your Rx's may have changed "TIERS". There are five drug tiers: Tier 1 is Preferred Generic, Tier 2 is Non-Preferred Generic, Tier 3 is Preferred Brand Name, Tier 4 is Non-Preferred Brand Name, and Tier 5 is a Specialty drug which is very expensive. The lower the tier, the cheaper the copay. Plus, be sure to use your plan's "Preferred" pharmacy & not the closest one to your home or the one with a drive-in window. That could cost you a lot of $$ over a 1 year time!!

Andrew Zurbuch, MBA · Answer

That is a great question. From my understanding the Insurance Companies for 2024 Part D coverage didn't have to cover all Rx insulins. A Medicare Beneficiary whom is concerned about their Rx costs for the next year should meet with a Broker during the Open Enrollment.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Diana Garner · Answer

The Inflation Reduction Act implemented a significant change to insulin costs for Medicare beneficiaries. As of January 1, 2023, the out-of-pocket cost of insulin is capped at $35 per month for each covered insulin product under Medicare Part D. This cap also applies to insulin covered under Medicare Part B (e.g., for traditional insulin pumps) as of July 1, 2023.

Answered by Diana Garner on June 13, 2025

Broker Licensed in KY, FL, IN, OH & TN

Answered by Diana Garner Medicare Insurance Agent

Sagrario &quot;Sage&quot; Dyer · Answer

No, it did not and not all insulins were part of the Reduction Act negotiated medications. A beneficiary maybe paying more due to the plans rise in deductible or a change in the medications tier level. Contact the plan's member services on the back of the card and ask what the estimated price will be over the course of the year.

Answered by Sagrario "Sage" Dyer on March 16, 2026

Broker Licensed in AZ, CA, CO & 10 other states

Answered by Sagrario "Sage" Dyer Medicare Insurance Agent

Kim Gibas · Answer

If your insulin costs have increased despite the IRA's provisions, it could be due to the specific insulin not being covered at the capped rate or other factors such as plan design or changes in the plans formularies . Reviewing your Part D plan's coverage annually during Annual Enrollment Period, 10/15 - 12/7, may help manage these costs, and by reaching out to a Licensed Medicare Broker or by going onto Medicare.gov drug lookup tool to ensure your not stuck with a Part D plan that does not work for you.

Answered by Kim Gibas on October 19, 2025

Broker Licensed in MI, FL & OH

Answered by Kim Gibas Medicare Insurance Agent

Tony Kiepe · Answer

Every prescription plan has its own formulary. They probably changed their formulary this year, and your insulin is not a preferred product under that plan. The best thing to do is go to Medicare.gov, enter your information to view prescription plans, and see if that product is available for $35.00, or call your local agent, who will be more than happy to assist you in making sure you have the best prescription plan. This is a good reason to have a fantastic agent who can help you and answer your questions.

Answered by Tony Kiepe on November 8, 2025

Agent Licensed in WA, AZ, ID & MT

Answered by Tony Kiepe Medicare Insurance Agent

Michael Roberts · Answer

You have likely experienced a deductible added to most plans this year. The deductible may be has high as $615 meaning you have to pay cash for your medications, including your insulin, until you reach the deductible. Once you reach the deductible your insulin co-pay will be no more than $35 per the Inflation Reduction Act.

Answered by Michael Roberts on January 12, 2026

Broker Licensed in NY

Answered by Michael Roberts Medicare Insurance Agent

David Tedrow · Answer

The IRA capped insulin costs — but it didn’t guarantee that your specific insulin would stay covered by your specific plan.
That’s why long-time plans can suddenly become bad fits.

Maureen Wark · Answer

It's very imprimatur to review your Part D plan each year during the Annual Enrollment Period.  Plans make changes to the prescriptions they cover and to their deductible and co-payments.
Your plan may have made changes for 2026 that impacted the medications you take.

Sabrina Mitter · Answer

The act stabilized insulin medication costs at $35 per month under Part D. You may be on a plan that changed its formulary medication list or the tier of your medication. You may be using an out-of-network pharmacy. Sounds like you could use a reevaluation of your plan. You have till the end of the month!

Answered by Sabrina Mitter on March 9, 2026

Agent Licensed in OH

Answered by Sabrina Mitter Medicare Insurance Agent

Mary Brown · Answer

The Inflation Reduction Act capped many Medicare Part D insulin costs at $35 per month, but not every insulin is covered the same way on every plan. Your cost may have increased because your plan changed its formulary, pharmacy network, tier placement, or because your insulin is not on the capped list for that plan. Reviewing your Part D plan each year is important.

Answered by Mary Brown on May 25, 2026

Broker Licensed in NJ, DE, FL & NC, OH, PA & TX

Answered by Mary Brown Medicare Insurance Agent

Suzanne Lamperti · Answer

You could call your plan and ask why the significant increase. The other option is to compare plans in your area and switch during AEP.

Todd Bostic · Answer

Yes insulin is guaranteed not to cost more than $35 for a one month supply, as long as it’s on the formulary. Not all insulin’s are covered by every plan. You should double check to make sure your medication is covered by your insurance during AEP every year so you don’t have the issue you are going through now.

Answered by Todd Bostic on March 23, 2026

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Dean Chiapetto · Answer

The IRA did limit the cost of Insulin. Make sure that you are using insulin and not another injectable. You should check with your local Broker each year on your part D plan, things change.
Brokers Make a Difference!

Eizel Mere · Answer

Part D plans change every year, prescriptions change tiers and with this price change occurs. It is important to go over the Part D plan every year to make sure it is still the best one for you. For a Part D Plan you can only make changes during AEP and OEP.

Answered by Eizel Mere on April 9, 2025

Broker Licensed in FL

Answered by Eizel Mere Medicare Insurance Agent

Julie Thompson · Answer

Insulin is generally not more than $35 but it may be the particular brand you are being prescribed. I suggest calling the customer service number of your carrier or your agent to help you understand why its increasing cost.

Answered by Julie Thompson on November 17, 2025

Agent Licensed in CA, AZ, KY, NV & TN

Answered by Julie Thompson Medicare Insurance Agent

Linda Davies · Answer

The cost of insulin in Medicare Part D could have increased due to a few factors. The Inflation Reduction Act of 2022 capped insulin costs at $35 per month for Medicare beneficiaries, but if your plan doesn't meet this requirement or if your insulin is covered on a higher tier, your out-of-pocket costs could be higher. 

Let’s review your Part D plan to find out why your costs might be increasing and what steps you can take.

Adam Paul · Answer

There are certain provisions within the inflation reduction act that are expiring by December 31, 2025. As a result, the cost of prescription drugs and healthcare are increasing. so to answer your question, the inflation reduction act is not fixing it.

Answered by Adam Paul on December 22, 2025

Broker Licensed in CA, NV, OK & OR

Answered by Adam Paul Medicare Insurance Agent

Jajuan Knox · Answer

The Inflation Reduction Act did lower insulin costs, but there are a few reasons you might still see a higher price. The law only caps your cost at $35 a month for insulin that your Part D plan actually covers, so if your plan changed its formulary, pharmacy network, or the specific insulin brand you use, your price could go up even though the cap is in place.

Answered by Jajuan Knox on February 20, 2026

Broker Licensed in FL, AK, AL & 49 other states

Answered by Jajuan Knox Medicare Insurance Agent

Rene Apack · Answer

I am very sorry that you kept the same Part D plan because you most likely overpaid out of pocket money that you did not have to.

Out-of-pocket costs change every year for all kinds of reasons.
It's in your best interest to shop your Medicare Prescription Drug Plan, Plan G, between October 15th and December 7th.

Get a Free consultation with me.

Best wishes,

Rene Apack

Anthony Albano · Answer

My advice is to compare plans. Go to www.medicare.gov. Enter ALL of your prescriptions and see what's out there for you. Best of luck !

Cindy Dedini · Answer

Most Part D plans have the IRA in place.  Talk with a licensed agent that can evaluation your your list of meds or go to medicare.gov to see the list of insulin costs.

Uchennah Okafor · Answer

The inflation reduction act is supposed to cap insulin at $35 and will not support the increase in the cost of your insulin. Can you check if your annual deductible has been met? This could be the reason. Another possible reason is whether you are not using the brand supported by your plan.

Answered by Uchennah Okafor on May 11, 2026

Agent Licensed in TX

Answered by Uchennah Okafor Medicare Insurance Agent

Rob Baer · Answer

The Inflation Reduction Act did fix insulin costs to a maximum $35 per month per type, provided it is on the carriers approved list. It sounds like your insulin may no longer be covered by your plan. Reach out to you plan, and ask. If they no longer cover your brand you have the option to change plans or change brands of insulin to one they do cover.

Answered by Rob Baer on April 20, 2026

Agent Licensed in SC, AL, CO & 15 other states

Answered by Rob Baer Medicare Insurance Agent

Diana Pedersen · Answer

Each year, you should sit down with a licensed Medicare Broker to have them verify the best plan for you based on your current medications, so you can be on the right plan based on your needs for the following year. The Inflation Reduction Act is mean to lower prescription drug prices. Certain insulins are capped at $35 per month, while others can be higher. The cost for copays of covered prescriptions, as of 2025 due to the Inflation Reduction Act, has a catastrophic limit of $2000 for the year.

Answered by Diana Pedersen on April 28, 2025

Agent Licensed in WA & ID

Answered by Diana Pedersen Medicare Insurance Agent

Theresa Furth · Answer

The Inflation Reduction Act did cap insulin costs at $35/month beginning January of 2023. However, if your insulin is not on your plan's formulary list or not covered on you Part D plan you will not be protected by the cap. Work with an agent to help find a plan that covers your insulin and that is protected with the Inflation Reduction Act.

Answered by Theresa Furth on October 30, 2025

Agent Licensed in VA, FL, ME & 5 other states

Answered by Theresa Furth Medicare Insurance Agent

Judith Carney · Answer

I believe at one time we all thought the passage of that Bill would keep insulin prices to only $35 per month; I know I did when I heard the announcement. Then I started working with healthcare and Medicare plans to learn that there are different "kinds" or categories of insulin including "rapid-acting, long-acting and pre-mixed" varieties. Medicare Part D and each Medicare Advantage plan can have different negotiated prices, copays, and formularies, which significantly affect how much patients pay. 
Always be certain to verify the full name of your prescribed insulin and dosage information with the formulary of the plan and check the pricing level before signing up for your coverage. 
I do this for all my clients!

Rene Casanova · Answer

The IRA did limit copays for insulin to $35 a month.  This is applied to all Prescription Drug plans.

Alyssa Scripter · Answer

The Inflation Reduction Act did introduce measures to lower insulin costs, including a $35 monthly cap on insulin copays for all Medicare Part D plans. However, if your insulin price has increased, it could be due to changes in your specific plan’s coverage or formulary adjustments

Answered by Alyssa Scripter on June 6, 2025

Agent Licensed in PA, CO, FL & 11 other states

Answered by Alyssa Scripter Medicare Insurance Agent

Ciriaco Gelera · Answer

The Inflation Reduction Act (IRA) did cap Medicare Part D insulin costs at $35 per month, but there is a critical catch: the cap only applies to insulins that are actively covered on your specific plan’s formulary.

If you have been on the exact same Part D plan for years, here is almost certainly what happened:

Why Your Price Spiked?
1 - Insurance carriers update their formularies (their list of covered drugs) every single year. They frequently negotiate new contracts with pharmaceutical manufacturers, which means they will drop certain brands of insulin and replace them with competitors.

2 - If your specific brand of insulin was removed from your plan's formulary for this calendar year, it is no longer protected by the IRA's $35 cap. Because it is now considered an "off-formulary" or uncovered drug, you are being charged the full retail price.

What You Can Do Right Now!
1. File a Formulary Exception: Your doctor can file an exception request with your Part D carrier. They will need to state that the insulins currently covered on the plan's formulary are not medically appropriate for you, or that you have had adverse reactions to them in the past. If the carrier approves the exception, your insulin will be covered and the $35 cap will apply.

2. Check State Assistance Programs: Programs like PAAD (Pharmaceutical Assistance to the Aged and Disabled) or Senior Gold in New Jersey are excellent safety nets for situations exactly like this. If you qualify based on income, these programs drastically reduce your pharmacy copays. More importantly, qualifying for PAAD grants you a Special Enrollment Period (SEP). This allows you to immediately switch to a different Part D plan that does cover your specific insulin right now, completely bypassing the wait for the Annual Enrollment Period in the fall.

Needs help? Reach out!

Jeanne LaChance · Answer

The Inflation Reduction Act put a $35/month copay cap on Part D plans. Each calendar year the plans change. You can review this yearly directly on line at Medicare.gov or with an advisor during the annual enrollment period (October 15 - December 7) to determine your best option for the upcoming year.

Answered by Jeanne LaChance on June 9, 2025

Broker Licensed in RI, CT, MA & NJ

Answered by Jeanne LaChance Medicare Insurance Agent

I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet?

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I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet?

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