does medicaid cover insulin

Does Medicaid Cover Insulin?

What is insulin?

Insulin is a hormone produced by the pancreas that plays a critical role in regulating the body’s metabolism of carbohydrates, fats, and protein. Insulin helps to regulate blood sugar levels by signaling cells in the body to absorb glucose from the bloodstream and use it for energy or storage.

In people with diabetes, the body either does not produce enough insulin or is unable to use it effectively. This leads to high blood sugar levels, which can cause a range of complications over time. Insulin therapy, which involves injecting insulin into the body, is used to help manage blood sugar levels in people with diabetes.

What insulin drugs exist?

There are several types of insulin, including rapid-acting, short-acting, intermediate-acting, long-acting, and combination insulin. The type of insulin and the dosing regimen used will depend on the individual’s specific needs and the type of diabetes they have. Insulin types are categorized by duration of action as follows:

  1. Rapid-acting insulin begins to work within 15 minutes of injection and typically peaks within one to two hours. It is used to control post-meal blood sugar spikes.
  2. Short-acting insulin starts working within 30 minutes of injection and typically peaks within two to three hours. This type of insulin is best used to control blood sugar levels between meals. 
  3. Intermediate-acting insulin takes longer to start working (one to two hours) and has a longer duration of action. It is typically injected twice daily and used to control blood sugar levels over a longer period of time, such as throughout the day or overnight.
  4. Long-acting insulin has an onset of action several hours after injection and a duration that can last up to 24 hours. This type of insulin only needs to be injected once a day. 
  5. Some insulin drugs combine two types of insulin, such as a rapid-acting insulin and a long-acting insulin, into a single injection. These medications are used for both immediate and extended blood sugar level control. 

Insulin Cost

A report to congress in 2022 by the US Department of Health and Human services revealed that high out of pocket costs affected insulin treatment adherence, forcing 17% of insulin users to ration their supplies. The report also showed that Medicare beneficiaries, which account for 52% of insulin users, had the highest total out of pocket healthcare spending for the drug when compared to privately insured and uninsured individuals’ costs.

However, this may change with the advent of the new $35 insulin cost cap that was introduced in 2023. The price cap applies to both private insurance plans and Medicare Part D plans, and it limits the cost of a 30 day supply of insulin to $35 per month.

You can use eNavvi to check insulin costs covered by your insurance.

Does Medicaid cover insulin?

Most people on Medicaid are able to get insulin for free or a few dollars at the pharmacy. However, because each state runs its own Medicaid program, coverage can vary greatly from state to state. There may be restrictions on who is covered, or what specific type of insulin is covered. Only 12% of insulin users have Medicaid, but a report from the US Department of Health and Human Services showed that Medicaid beneficiaries were the most protected from high out-of-pocket costs.

Does Medicaid cover insulin pumps?

Medicaid coverage for insulin pumps varies based on a number of factors such as type of diabetes, state location, and severity of condition. Most patients with type 1 diabetes will be able to obtain an insulin pump that is covered by Medicaid, whereas patients with type 2 diabetes may have to prove that there is a necessity for the device. 


The information included in this page is not a substitute for medical advice. The list of side effects may not include all side effects as drugs can affect all people differently. Any dosage information may not include all dosage information. It is important to discuss with a medical professional that knows your medical history well which dosage is right for you and if there are any potential risks or possible side effects. Our goal is to provide relevant information but this page may not include all up-to-date information. v

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