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State of Delaware

Delaware Insulin & Pump Cap

$100 insulin / $0 insulin pumps / $35 other supplies per 30-day on state-regulated 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

$100per 30-day fill
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Covered medications

  • Any insulin covered by your plan 30-day supply
  • Insulin pumps (any brand) $0 cost-share
  • Other diabetes supplies (test strips, lancets, etc.) $35/30-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 DE.
Income limits?
No income test.

Accepted

  • Delaware residents on a state-regulated commercial plan
  • Insulin, pumps, and supplies all covered
  • Auto-applied — no application required

Not accepted

  • Out-of-state residents
  • Self-funded ERISA employer plans
  • Medicare Part D, Medicaid, federal plans
  • High-deductible health plans (HDHPs) and catastrophic plans

How to apply

  1. Present your insurance card at the pharmacy — the caps are auto-applied if your plan is state-regulated
  2. If billed over the cap, ask your insurer whether your plan is state-regulated or a self-insured ERISA plan
  3. If denied on a state-regulated plan, file a complaint with the Delaware Department of Insurance

Using it at the pharmacy

No card needed — Delaware caps insulin at $100, insulin pumps at $0, and other supplies at $35 per 30-day on state-regulated plans automatically.

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. Insulin pumps are fully covered ($0 cost-share). Cap does NOT apply to HDHPs or catastrophic plans.

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