By Amber Jackson, RN, DCES
Great news! Your state passed a law capping the cost of insulin.
So your insulin is price-capped…right?
Well, not necessarily.
Welcome to the fine print of insulin caps—where having diabetes, having insurance, AND living in a state with an insulin-cap law still may not qualify you for the capped price.
A 2026 study published in Diabetes Care examined state insulin out-of-pocket cap laws across the United States. By 2026, 29 states and Washington, D.C. had enacted insulin caps for state-regulated commercial insurance plans.
Sounds promising.
Then you look at who is actually protected by the price cap.
~991,000 protected vs. ~2.9 MILLION not protected.
Researchers estimated that approximately 991,370 adults with insulin-treated diabetes were enrolled in state-regulated insurance plans that qualified for an insulin cap.
Meanwhile, approximately 2,914,293 commercially insured adults using insulin were NOT protected by a state insulin cap. That’s roughly 3 out of every 4 people in the population studied. Yes. About 75% were left out.
How Is That Possible?
State laws can only regulate state-regulated insurance plans. But many Americans receive health insurance through employers that operate self-funded plans regulated at the federal level. Those plans generally fall outside state jurisdiction—which means your state’s insulin-cap law generally can’t require them to give you the discounted price.
Of the approximately 2.9 million people left without state-cap protection, 672,600 had state-regulated insurance but lived in a state without an insulin-cap law. But another 2.24 MILLION had federally regulated commercial insurance plans that are not subject to the state insulin-cap laws.
So yes, you can live in a state that proudly announces an insulin price cap, walk into the pharmacy expecting to pay that price, and discover that your particular insurance plan isn’t subject to the law.
Because apparently diabetes wasn’t complicated enough already!!!
Does My Insulin Cap Apply to Me?
Flow through this to find out:
Do you have Medicare?
→ Medicare has separate federal insulin cost protections, so state insulin-cap laws aren’t what determine your benefit.
Do you have commercial/private insurance?
Ask: “Is my health plan fully insured/state-regulated, or is it a self-funded employer plan?”
- If State-regulated plan + your state has a cap? YES — the state insulin cap may apply.
- If State-regulated plan + your state doesn’t have a cap? NO state insulin cap.
- If Self-funded/federally regulated employer plan? No, Your state’s insulin-cap law generally does NOT apply.
Not sure which one you have? Call the number on the back of your insurance card and specifically ask whether your plan is “fully insured/state-regulated” or “self-funded/ERISA.” Don’t assume that having insurance through a major insurance company tells you the answer—the company may simply administer a self-funded employer plan.
Does My State Have an Insulin Cap?
According to the American Diabetes Association’s current list, these states have insulin copay caps for qualifying state-regulated plans:
$0: New York
$25: Connecticut, Massachusetts, Minnesota*, New Mexico, North Dakota, Texas
$30: District of Columbia, Kentucky, Maryland, New Hampshire, Oklahoma, Utah
$35: California*, Illinois, Maine, Montana, Nebraska, Nevada, New Jersey, Oregon, Washington, West Virginia
$40: Rhode Island
$50: Virginia
$75: Louisiana
$100: Alabama, Colorado, Delaware, Vermont
Note: Some state laws have additional conditions or different caps for medications, supplies, plan types, or effective dates. California’s $35 cap, for example, is currently effective for state-regulated large-group plans and expands to small-group plans in 2027. Minnesota also has additional diabetes medication/supply provisions.
So…What Exactly Are We Capping?
State insulin caps are progress. For the nearly one million people who qualify, limiting out-of-pocket insulin costs can make an important difference. But calling them simply “insulin caps” can make the protection sound much broader than it actually is. That’s why the study authors argue that state legislation alone isn’t enough. Federal action would be necessary to extend similar protections to millions of people currently outside state jurisdiction.
And this isn’t just a theoretical policy discussion.
Insulin is not optional.
For someone who depends on insulin to live, affordability can determine whether they fill a prescription, stretch what they have, ration doses—or have to choose between insulin and another basic expense.
So yes, insulin caps are a step forward.
But when approximately 991,000 people are protected while 2.9 MILLION remain outside the protection, there’s still an awfully large asterisk attached to the word “cap.”
For more information about insulin affordability, diabetes management, or resources that may help reduce the cost of diabetes care, contact Integrated Diabetes Services (IDS). Our team can help you navigate the increasingly complicated world of diabetes care and find strategies and resources that fit your individual needs.
Resources
Wang R, et al. State Insulin Out-of-Pocket Cap Policies and Estimated Eligible Populations in the United States, 2019–2026. Diabetes Care. 2026. doi:10.2337/dc26-0300.
