JAMA Intern Med
$35 insulin cap cuts costs, improves diabetes control
1200x720
Clinical takeaway: The Medicare insulin cap improved affordability and access in real-world care. Expect better insulin use and modest glycemic benefit; continue to monitor for hypoglycemia as access improves.
A national, observational cohort study examined whether Medicare’s $35 monthly insulin cap changed spending, access, and diabetes outcomes after it began for some patients in 2021 and expanded to all beneficiaries in 2023.
Investigators analyzed interrupted time-series data from 4.8 million Medicare beneficiaries with type 2 diabetes, with linked electronic medical record data available for a subset.
Mean quarterly insulin out-of-pocket spending fell by $47.90 after 2021 from a baseline of $192.66, and by an additional $58.59 after 2023.
The share of insulin users paying more than $35 per 30-day supply dropped from 62.14% to 0.11% by late 2023. Mean daily insulin use increased, while mean HbA1c fell from 7.28% by 0.06 percentage points after 2023. Severe hypoglycemia increased slightly. HbA1c data were available for only 2.4% of the full cohort.
“Federal cost-sharing policies could improve access and adherence to essential medications in diabetes and other chronic diseases,” the study concludes.
Source: Hong D, et al. JAMA Internal Medicine. April 6, 2026. Out-of-Pocket Spending for Insulin by Medicare Beneficiaries After Monthly Caps