Insulin Cost With and Without Insurance in 2024

The cost of insulin has steadily increased over the past few years. This price rise is disproportionate to annual inflation. It poses a threat to people living with diabetes who cannot afford to pay for these increased prices but need insulin to survive. The retail price for insulin can be over $140 for a brand-name Humalog KwikPen; however, patients can now pay about $60 for generic insulin such as lispro KwikPen.

How Much Insulin Costs Without Insurance

Retail prices for generic insulin lispro and insulin aspart are about half that of their brand-name counterparts, Humalog and Novolog. This is the same for generic mixed insulins, insulin lispro 75/25 and insulin aspart 70/30, compared to Humalog 75/25 and Novolog 70/30.

Retail Prices of Mixed Insulins

Retail Prices of Traditional Insulins

Novolin R and Novolin N are currently the cheapest traditional insulins. The average unit prices are about $0.10.

Cost With Private Insurance

Insulin coverage under private insurance plans varies widely, but it's commonly recognized as a necessary treatment for many individuals with diabetes. Most private insurance policies do cover some form or types of insulin, but the exact coverage can differ significantly

• Tiered Drug Lists: Many insurance companies use a tiered drug list (also known as a formulary) for prescription coverage. Insulin might be categorized under a generic, preferred brand, non-preferred brand, or specialty tier. Generally, generic tiers have the lowest copays, followed by preferred brands, with non-preferred and specialty drugs typically having the highest copays.
• Copay Amounts: Depending on the tier, copays can range from as low as $5 to $10 for generic versions, $25 to $50 for preferred brands, and potentially $50 to $100 or more for non-preferred or specialty brands per month. Some plans may also have coinsurance (a percentage of the drug's cost) instead of a flat copay.
• High Deductible Health Plans (HDHP): For those with HDHPs, they might have to pay the full cost of insulin until their deductible is met, after which they would pay a copay or coinsurance.
• Cap on Insulin Costs: Due to the rising prices of insulin, some states in the U.S. have implemented or are considering caps on out-of-pocket insulin costs. Where these are in place, insured individuals may have a capped copay, like $25 or $50 per month regardless of the insulin's list price.
• Manufacturer Coupons & Assistance Programs: Some individuals use manufacturer coupons or patient assistance programs to reduce out-of-pocket costs, though not all insurance plans allow these.

Cost with Medicare

Medicare Part B:

• Coverage: Medicare Part B (Medical Insurance) may cover insulin, but only if it's administered with an insulin pump that's covered under Part B. It doesn't typically cover other forms of insulin administration like insulin pens or vials if not used with a pump.
• Copay: After meeting the yearly Medicare Part B deductible, beneficiaries typically pay 20% of the Medicare-approved amount for the insulin pump and the insulin.

Medicare Part D:

• Coverage: Medicare Part D (Prescription Drug Coverage) covers a broad array of prescription drugs, including insulin not used with a pump. So, insulin pens, inhaled insulin, and insulin vials for injection are generally covered under Part D.
• Copay: Copays for insulin under Part D can vary depending on the specific plan and tiered formulary system. There might be different copay amounts for generic versus brand-name insulins. In some cases, beneficiaries might enter the "donut hole" or coverage gap, which can affect out-of-pocket costs, though there have been efforts to reduce costs for insulin in this stage.

Medicare Advantage Plans (Part C):

• Coverage: Medicare Advantage plans must cover everything Original Medicare (Parts A and B) covers, but can have different rules, costs, and restrictions. They often also come with their own Part D coverage.
• Copay: The copay for insulin under a Medicare Advantage Plan can vary depending on the specifics of the plan. It's crucial to check with the individual plan provider for exact costs.

Senior Savings Model:

• Starting in 2021, the Centers for Medicare & Medicaid Services (CMS) introduced the Part D Senior Savings Model, which caps copays for insulin at $35 for a month's supply for participating plans, providing a significant savings for many beneficiaries.

Factors that Influence the Cost of Insulin

Between 2001 and 2018, the average list price of insulin increased 11% annually. This equates to average annual per capita insulin costs nearing $6000. Since a patient's out-of-pocket costs are based on the list price, consumers have undoubtedly felt the burden of these price increases. 

Diabetes patients' need for insulin to survive is indisputably one of the largest determinants of insulin cost. Insulin and insulin analogs are the only drugs able to save the lives of diabetes patients; therefore, consumers' need for these drugs to stay alive gives way to high pricing for profits. In other words, since diabetic patients have no other options, they have no other choice but to pay the price that the stakeholders set. 

The three primary factors in the pricing of insulin vials are as follows:

1. Pharmaceutical & Insurance Companies
2. The Government
3. Generic vs. Brand Name

Pharmaceutical & Insurance Companies

The "Big Three" pharmaceutical companies that produce 90% of the insulin available on the market are Eli Lilly, Novo Nordisk, and Sanofi Aventis. Insurance companies will determine how much you pay out of pocket, depending on your type of plan and what cost-sharing policies are in place. 

For instance, those with more comprehensive insurance plans are likely to spend less than those with high deductibles. 

The Government

The government plays a role by regulating pharmaceutical patents and FDA approvals. Patent regulation is a key component of how insulin prices remain high because insulin patents are continually renewed by the government, preventing generics from entering the market to compete and thereby keeping prices high. As of 2022, the government has begun voting on introducing a price cap on insulin. The government passed a bill, that states Medicare recepiants will have a price cap of $35. For those who don't have Medicare, more affordable insulin is still being fought for.

Locate a drug discount program

You most likely won’t be able to apply these to your insurance, but your insulin could cost less if you only used a discount program such as Benefits Check Up and Needy Meds.

Generic vs. Brand Name

Like most prescription drugs, accessing prescriptions using the generic version will likely be significantly less expensive when compared to the brand-name drug.

When it comes to insulin, it's no different: retail prices for generic insulin lispro and insulin aspart are about half as expensive when compared to their brand-name counterparts, Humalog and Novolog. It's also the same for the generic mixed insulins, insulin lispro, and insulin aspart, compared to Humalog and Novolog.

Insulin Frequently Asked Questions (FAQs)

Below we answer some frequently asked questions when it comes to insulin.

Are there generic versions of insulin?

In 2019, Eli Lilly released the first generic insulin, Insulin lispro, which is the counterpart to the popular rapid-acting insulin Humalog. Since then, the FDA has approved generic versions of Humalog (Insulin lispro), Novolog (Insulin aspart), and Novolog.

Why is insulin so expensive?

For the past few years, the price of insulin has skyrocketed — due in large part to the extended monopoly a handful of companies have over insulin manufacturing. 

While annual out-of-pocket costs are expected to rise with inflation, the annual price increases for insulin are disproportionate to overall inflation. Studies demonstrate that diabetes is the most expensive chronic disease in the United States, costing more than $327 billion in 2017.

Is it ok for me to skip insulin doses?

With the rise in insulin prices, the financial cost of diabetes is perhaps more serious now than ever before. While skipping insulin may seem like an immediate solution, rationing doses is not a proper nor medically advisable technique for diabetes management. In fact, skipping doses can lead to more serious diabetes-related health issues, such as diabetes ketoacidosis, costing the consumer more out of pocket in the long run. 

The Bottom Line

Many things come into play when it comes to the cost of insulin. While it can be costly, it's important to utilize ways to access insulin, such as patient assistance programs or Medicare. Another way to access affordable healthcare is using Mira. For an average of $45 per month, members can get access to affordable virtual and in-person urgent care visits, discounted prescriptions, and low-cost lab testing. Sign up today.