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District of Columbia

District of Columbia Insulin & Supplies Cap

$30/30-day insulin and $100/30-day diabetes supplies on DC-regulated commercial plans, automatic at the pharmacy.

Application requiredCommercial insurance only

What you need to enroll

Application required

Fill out an application — income or residency documents may be needed. Approval typically takes 1–2 weeks. You'll need an active prescription to use the program once you're approved.

Your estimated copay

$30per 30-day fill
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Covered medications

  • Any insulin covered by your plan 30-day supply
  • Diabetic equipment and supplies covered by your plan $100/30-day cap

Am I eligible?

Need a prescription?
Yes — written by a licensed prescriber for the medications below.
Insurance required?
Commercial insurance only. Medicare, Medicaid, TRICARE, and VA are not eligible.
State restrictions?
Only available in DC.
Income limits?
No income test.

Accepted

  • DC residents on a DC-regulated commercial plan
  • Insulin and diabetes supplies covered
  • Auto-applied — no application required

Not accepted

  • Out-of-DC residents
  • Self-funded ERISA employer plans
  • Medicare Part D, Medicaid, federal plans

How to apply

  1. Present your insurance card at the pharmacy — the cap is auto-applied if your plan is DC-regulated
  2. If billed more than $30 for insulin (or $100 for supplies), ask your insurer whether your plan is DC-regulated or a self-insured ERISA plan
  3. If denied on a DC-regulated plan, file a complaint with the DC Department of Insurance, Securities and Banking
  4. Medicare patients: use the federal $35/month insulin cap

Using it at the pharmacy

No card needed — DC caps insulin at $30 and diabetic supplies at $100 per 30-day automatically on DC-regulated plans.

Terms & limits

Fills per year
12 fills per year, per covered drug
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No application required. Self-insured ERISA plans are exempt — those are federally regulated. The $100 supplies cap covers diabetic equipment and supplies.

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