State of West Virginia

West Virginia $35 Insulin / $100 Supplies Cap

$35/30-day insulin and $100/30-day diabetic equipment & supplies on state-regulated plans (eff. 1/1/2024), 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
Start application

Covered medications

  • Any insulin covered by your plan 30-day supply
  • Diabetic equipment and supplies covered by your plan $100/30-day 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 WV.
Income limits?
No income test.

Accepted

  • West Virginia residents on a state-regulated commercial plan
  • Insulin and 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 cap is auto-applied if your plan is state-regulated
  2. If billed more than $35 (or $100 for supplies), call the number on the back of your insurance card to confirm your plan is following WV law
  3. If denied on a state-regulated plan, file an appeal with your health insurer or contact the WV Offices of the Insurance Commissioner
  4. WV Medicaid patients: cost-sharing is managed through the state preferred drug list
  5. Medicare patients: use the federal $35/month insulin cap

Using it at the pharmacy

No card needed — West Virginia caps insulin at $35 and supplies at $100 per 30-day automatically on state-regulated plans.

Terms & limits

Fills per year
12 fills per year, per covered drug
Start application

No application required. Self-insured ERISA employer plans are exempt — those are federally regulated. SB 577 added the cap effective 1/1/2024.

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