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State of North Dakota

North Dakota $25 Insulin & Supplies Cap

$25/30-day insulin and basic diabetes supplies on state-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

$25per 30-day fill
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Covered medications

  • Any insulin covered by your plan 30-day supply
  • Basic diabetes supplies covered by your plan 30-day supply

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 ND.
Income limits?
No income test.

Accepted

  • North Dakota residents on a state-regulated commercial plan
  • Insulin and basic diabetes supplies covered
  • 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 North Dakota Insurance Department
  4. Medicare patients: use the federal $35/month insulin cap

Using it at the pharmacy

No card needed — the cap applies automatically on ND state-regulated plans at $25 per 30-day insulin (and basic diabetes supplies).

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 $25 cap covers both insulin and certain basic diabetes supplies. HB 1114 effective date for commercial-plan extension is 2025 — confirm whether it applies to plans issued/renewed in 2025 or 2026.

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