Part D drug formularies seem to be changing drastically – popular insulins are being dropped from formularies like never before and generic alternatives are flooding the markets. Major manufacturers continue to cite decreasing patient coverage, availability of alternative treatments, and global manufacturing issues as reasons for formulary changes.
If you are one of the 7 million people in the U.S. on insulin, this is very scary and may leave you scrambling to find alternatives. The good news is that many insulin options are available, and some newer alternatives may offer more convenient dosing schedules than what you're currently taking. Here are some options for you to discuss with your provider.
Long-Lasting Insulin Options
- Basaglar (generic: Insulin glargine)
- Lantus (generic: Insulin glargine)
- Toujeo (generic: Insulin glargine)
- Tresiba (generic: Insulin degludec)
- Novolin N
Rapid-Acting / Short-Acting Insulin Options
- Humalog (generic: Insulin Lispro)
- Novolog (generic: Insulin Aspart)
- Apidra (generic: Insulin Glulisine)
- Novolin R
If you are a Medicare beneficiary on Part D, it is important to note that as of today, most Part D formularies are not covering the generic versions of the popular insulins shown above so most likely, you will have to switch to another "brand" insulin in the same family. Remember, insulin costs are capped at $35 per month, so no matter which insulin your doctor recommends, it will still be affordable. Keep in mind that these insulins are "similar" but not "identical" which means side effects can vary. Make sure to ask your pharmacist for a list of side effects to watch for and be sure to notify your doctor of any that you experience.
Do not hesitate to call us at 877-220-1089 if you have any questions regarding Medicare or Retirement as we are here to make your Medicare and Retirement journey 123Easy!
By American Retirement Advisors
American Retirement Advisors helps retirees and pre-retirees navigate Medicare, estate planning, and retirement income — so you can enjoy the retirement you've earned.
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Easy Eddie's Take
This is spot on that Medicare Part D formulary changes can feel overwhelming, but here's the good news: the Medicare Part D Senior Savings Model guarantees that covered insulin costs are capped at $35 per month for 2026, regardless of which brand your doctor prescribes. This applies to all insulin products covered under your Medicare Part D prescription drug plan, whether you're in the deductible phase, coverage gap, or catastrophic coverage phase.
Most people are surprised when they learn that Medicare Part D plans can change their formularies each year, usually during the Annual Open Enrollment Period from October 15th to December 7th. If your current insulin gets dropped from your plan's formulary, you have a few options: your doctor can request a formulary exception, you can switch to a covered alternative insulin, or you can change to a different Part D plan that covers your preferred insulin during the next open enrollment period.
Here's what I tell folks: work with your doctor and pharmacist as a team. Your doctor knows which insulin works best for your blood sugar control, and your pharmacist can check which insulins are on your specific Part D plan's formulary for the year. A little preparation during open enrollment can save you a lot of hassle later.