Insulin Affordability Crisis Persists Despite Legislative Efforts

<figure> <img alt="Insulin vial" src="https://platform.vox.com/wp-content/uploads/sites/2/2026/09/GettyImages-1470812510.jpg?quality=90&amp;strip=all&amp;crop=0,0,100,100" /> <figcaption> Millions of people continue to struggle to pay for their insulin and having their long-term health put at risk. | Spencer Platt/Getty Images </figcaption> </figure> <p class="wp-block-paragraph">A decade ago, insulin became a focal point for discussions regarding high drug prices in the United States. The 2017 death of Alec Smith, who was rationing his insulin, and ongoing price increases for a medication that has been available for over a century sparked significant public concern about the affordability of this essential treatment.</p> <p class="wp-block-paragraph">In response, various legislative measures were introduced. Starting with a Colorado law in 2019, 27 states and Washington, DC, have enacted laws to cap out-of-pocket costs for insulin. Additionally, the Inflation Reduction Act of 2022 established a $35 monthly cap on insulin prescriptions for Medicare beneficiaries. Following these developments, some drug manufacturers announced reductions in cash prices for uninsured patients.</p> <p class="wp-block-paragraph">However, many in the diabetes community warn that the crisis is far from resolved. Millions continue to face challenges affording insulin, jeopardizing their long-term health. Shaina Kasper, executive director of T1 International, stated that despite the legislative actions, rationing rates among insulin users have not improved, with a 2024 survey indicating that 34% of insulin users reported rationing their medication.</p> <p class="wp-block-paragraph">Dr. Kasia Lipska, an endocrinologist at the Yale Diabetes Center, noted that the complexities of insurance coverage and access to insulin contribute to ongoing affordability issues. Many Americans remain uninsured, facing high cash prices for insulin, and the process to obtain discounts can be complicated.</p> <p class="wp-block-paragraph">The federal $35 cap applies only to Medicare, leaving many privately insured individuals without similar protections. State laws often exclude larger self-funded plans, leaving millions without a cap on their insulin costs. A national estimate indicated that approximately 775,000 privately insured insulin users were protected by state caps in 2025, while over 1 million were not.</p> <p class="wp-block-paragraph">Even those benefiting from the caps may still struggle to afford insulin, as individual needs vary and pharmacies may not always have the required products in stock. As a result, some patients may end up paying significantly more than the capped price.</p> <p class="wp-block-paragraph">Despite legislative efforts, many Americans remain at risk of serious health complications due to inadequate access to insulin. The advocacy community continues to push for comprehensive reforms, including potential government involvement in insulin production to ensure affordability.</p> <p class="wp-block-paragraph">Some states are exploring initiatives to support low-cost insulin production, with Oklahoma passing a bill to fund private companies that commit to producing affordable insulin. California is also working towards establishing government-owned facilities for insulin production, although these initiatives may take years to implement.</p> <p class="wp-block-paragraph">While immediate assistance is available through organizations like T1 International, the long-term solution to the insulin affordability crisis will require sustained advocacy and legislative action. Kasper emphasized that the perception that the crisis has been resolved is misleading, as many continue to face significant barriers to accessing affordable insulin.</p>