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State of Washington

Washington $35 Insulin Cap (SB 5729)

Permanent $35/30-day cap on state-regulated commercial plans (including PEBB/SEBB public employee 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

$35per 30-day fill
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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 WA.
Income limits?
No income test.

Accepted

  • Washington residents on a state-regulated commercial plan (incl. PEBB/SEBB)
  • 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 $35 cap is auto-applied if your plan is state-regulated (individual, group, or PEBB/SEBB)
  2. If billed more than $35, call the number on the back of your insurance card to confirm your plan is following WA law
  3. If denied on a state-regulated plan, file a complaint with the Washington Office of the Insurance Commissioner
  4. Out of insulin and can't wait? Washington also has a 30-day emergency supply program — ask any WA pharmacist for the $35 emergency dispense
  5. Medicare patients: use the federal $35/month insulin cap

Using it at the pharmacy

No card needed — the cap applies automatically. WA state-regulated plans top out at $35 per 30-day insulin fill (SB 5729).

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. SB 5729 made the $35 cap permanent in 2023 (replacing the earlier $100 cap under SB 6087).

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