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Commonwealth of Massachusetts

Massachusetts $25 Insulin Cap

$25/30-day insulin cap on state-regulated commercial plans, automatic at the pharmacy. PACT Act 3.0 also provides $0 for selected generic diabetes drugs.

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

$25per 30-day fill
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Covered medications

  • Any insulin covered by your plan 30-day supply
  • Selected generic diabetes drugs (per PACT Act 3.0) $0 cost-share

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 MA.
Income limits?
No income test.

Accepted

  • Massachusetts residents on a state-regulated commercial plan
  • Auto-applied — no application required

Not accepted

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

How to apply

  1. Present your insurance card at the pharmacy — the $25 cap is auto-applied if your plan is state-regulated
  2. If billed more than $25, 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 Massachusetts Division of Insurance
  4. Medicare patients: use the federal $35/month insulin cap

Using it at the pharmacy

No card needed — the cap applies automatically on MA state-regulated plans at $25 per 30-day insulin fill.

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. Under PACT Act 3.0, MA state-regulated commercial plans also cover selected generic diabetes drugs at $0 cost-share — ask your pharmacist or insurer which generics qualify.

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