Barriers to access to insulin and other diabetes supplies can include unaffordable health care, institutional unresponsiveness, and major life transitions. Being unable to afford or access insulin or other required supplies is not the fault of any of us as individuals; rather it is the outcome of decades of intentional policies and practices by Big Pharma.
You are not alone: about 10% of people in the United States do not have health insurance, 1 in 4 people with type 1 diabetes have experienced interruptions in their health insurance, and about 60% of people without insurance in the US are people of color.
The ‘Big Three’ insulin producers, Eli Lilly, Novo Nordisk, and Sanofi, dominate more than 90% of the insulin market, meaning they can charge high prices. One in three people living in the United States with type 1 diabetes reported the dangerous practice of rationing their insulin due to price as the average patient cost of insulin has skyrocketed, resulting in devastating health complications and emergencies.
Note: This resource section covers ongoing insulin access in the United States; see here for emergency insulin access in the United States
Note: If you are an undocumented aspiring American or a DACA recipient, you are not eligible for health insurance through the above pathways. Some people who were eligible for different above insurances before the passage of HR 1 lost that eligibility and will be disenrolled by Jan 2027.
Blue Circle Health provides free clinical care and insurance navigation to adults living with type 1 diabetes living in Alabama, Connecticut, Delaware, Florida, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, New Hampshire, Ohio, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, and Washington D.C. for up to six months.
Medicaid and CHIPare state-administered health insurance program for low-income individuals and families. Each state has their own eligibility requirements, often including pregnant people, children, parents, people with disabilities, and Medicare beneficiaries. Medicaid expansion states can extend eligibility to low-income adults. Medicaid covers health care and prescriptions; costs vary by state. The Children’s Health Insurance Program (CHIP) is a state-administered health insurance program for children from families too high to qualify for Medicaid and some pregnant people and parents. The Health Insurance Marketplace in each state offers a single application to determine eligibility for Medicaid, CHIP, and the private marketplace.
Medicare is a federal government health insurance program for citizens over 65 years old or with certain health conditions. You will have to pay to be on Medicare insurance. As of 2023, Medicare insurance plans cannot charge patients more than $35 for a one-month supply of each insulin you take.
Affordable Care Act or Marketplace health insurance plans are state-administered private health insurance programs available for citizens in each state. You will have to pay to be on a Marketplace insurance plan and sign up during Open Enrollment between Nov 1 and Jan 15 or if you have a qualifying life event. You can qualify for savings like a premium tax credit to lower your monthly plan or find out if you qualify for Medicaid or CHIP (noted above) by applying for Marketplace coverage. As of 2014 all health insurance plans cannot deny coverage or charge more because of diabetes or other preexisting conditions like diabetes, and many states have copay caps for monthly insulin prescriptions for state-based plans.
Free & Charitable Clinics and Community Health Centers assist the medically underserved in communities across the U.S. by ensuring that they have access to affordable health care. You may have to get insulin at the clinic-run pharmacy following your clinical care appointment.
Mutual aid programs like Mutual Aid Diabetes, Diabetes Aid Now, and others can provide supplies directly through volunteer-managed and volunteer-run mutual aid networks. Mutual Aid Diabetes seeks to ensure every member of the diabetes community has access to adequate supplies, medications, insulin, and sustainability resources via facilitated peer support. Their network may be able to get you one-time access to insulin and supplies, as well as help you find and navigate sustainable long-term solutions like insurance navigation.
Manufacturer-sponsored cost-sharing programs, without strong price cutting measures and equitable insulin access, are not an answer to the insulin crisis. They are always time-limited and there is no guarantee that these programs will continue long-term—companies can end them at any time, putting patients at risk again. Sometimes extensive paperwork also requires the time and attention of health professionals. Reliance on coupons, savings cards, and patient assistance programs can circumvent efforts to use more cost-effective generic or biosimilar drugs. There are three main types of manufacturer-sponsored cost-sharing programs for insulin:
ArrayRx is a state-managed drug discount care program available for patients in Arizona, Connecticut, Nevada, Oregon, and Washington, as well as certain people in other states.
Often private drug discount programs and cards cannot be used with your health insurance, meaning you either pay the insurance price or the cash price set by the program. In the long run, they may end up costing patients more money. Read about one patient’s experience here. See “A note about Insulin Manufacturers’ Insulin Affordability Resources” above. Many of these other resources receive funding from insulin manufacturers, sell data, etc.