State of Texas

Texas $25 Insulin Cap

$25/30-day insulin cap 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

Start application

Covered medications

Any insulin 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 TX.
Income limits?: No income test.

Accepted

Texas 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

Present your insurance card at the pharmacy — the $25 cap is auto-applied if your plan is state-regulated
If billed more than $25, ask your insurer whether your plan is state-regulated or a self-insured ERISA plan
If denied on a state-regulated plan, file a complaint with the Texas Department of Insurance
Medicare patients: use the federal $35/month insulin cap

Using it at the pharmacy

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

Terms & limits

Fills per year: 12 fills per year, per covered drug

Start application

No application required. Self-insured ERISA plans are exempt — those are federally regulated.

Be first when we launch — we'll save these matches and remind you to renew.

Join the waitlist

Start application