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State of Virginia

Virginia Insulin & Diabetes Equipment Cap

$50/30-day insulin (drops to $35 eff. 7/1/2026); $35 for diabetes equipment & supplies — automatic on state-regulated plans.

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

$35per 30-day fill
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Covered medications

  • Any insulin covered by your plan 30-day supply
  • Diabetes equipment and supplies covered by your plan 30-day supply ($35 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 VA.
Income limits?
No income test.

Accepted

  • Virginia residents on a state-regulated commercial plan
  • Insulin and diabetes equipment / 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 cap is auto-applied if your plan is state-regulated (employer or ACA marketplace plans typically qualify)
  2. If billed more than $50 (or $35 for supplies), call the number on the back of your insurance card to confirm your plan is following Virginia law
  3. If denied on a state-regulated plan, file a complaint with the Virginia State Corporation Commission Bureau of Insurance
  4. Medicare patients: use the federal $35/month insulin cap (Part D and Part B)

Using it at the pharmacy

No card needed — the VA state cap applies automatically at the pharmacy ($50 insulin / $35 supplies; insulin drops to $35 effective 7/1/2026).

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. Cap drops from $50 to $35 effective 7/1/2026 (sources disagree — one source says 1/1/2027; verify HB 1214 final effective date once signed). Uninsured Virginians can also look at free clinics (e.g. The Health Wagon) for pharmacy assistance.

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