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.
Coverage Eligibility How to use Terms & limits
Any insulin covered by your plan 30-day supply Diabetic equipment and supplies covered by your plan $100/30-day cap
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 Present your insurance card at the pharmacy — the cap is auto-applied if your plan is state-regulated 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 If denied on a state-regulated plan, file an appeal with your health insurer or contact the WV Offices of the Insurance Commissioner WV Medicaid patients: cost-sharing is managed through the state preferred drug list Medicare patients: use the federal $35/month insulin cap No card needed — West Virginia caps insulin at $35 and supplies at $100 per 30-day automatically on state-regulated plans.
Fills per year 12 fills per year, per covered drug 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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