{"answer":{"topic":"insulin_caps","states_listed":16,"meaning":"the cost-sharing cap each listed state statute states, in the quoted sentence; a limit on what a covered person can be required to pay under a covered plan, not a price and not a promise about any plan","rows":[{"state":"CO","source_url":"https://leg.colorado.gov/sites/default/files/2019a_1216_signed.pdf","read_on":"2026-11-07T07:43:24.676Z","proof_state":"verified","fact_id":"62f4a600a9318826a30279ee","cap_usd":100,"per":"30-day supply","plan_types":[{"text":"health coverage plans offered by a carrier","untrusted":true}],"effective":"NOT_STATED","effective_text":{"text":"This act applies to health coverage plans issued or renewed on or after January 1, 2020, or the date of the official declaration of the vote by the governor, whichever is later.","untrusted":true},"insulin_specific":true,"notes":[],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"session law as enacted (signed bill)","untrusted":true},"cite":{"text":"C.R.S. 10-16-151 as added by HB19-1216","untrusted":true},"quote":{"text":"A CARRIER THAT PROVIDES COVERAGE FOR PRESCRIPTION INSULIN DRUGS PURSUANT TO THE TERMS OF A HEALTH COVERAGE PLAN THE CARRIER OFFERS SHALL CAP THE TOTAL AMOUNT THAT A COVERED PERSON IS REQUIRED TO PAY FOR A COVERED PRESCRIPTION INSULIN DRUG AT AN AMOUNT NOT TO EXCEED ONE HUNDRED DOLLARS PER THIRTY-DAY SUPPLY OF INSULIN","untrusted":true}},{"state":"DE","source_url":"https://delcode.delaware.gov/title18/c033/sc01/index.html","read_on":"2026-11-07T07:44:56.508Z","proof_state":"verified","fact_id":"720d31a1913da74720d6deb4","cap_usd":100,"per":"month","plan_types":[{"text":"individual health insurance policy, contract, or certificate","untrusted":true}],"effective":"NOT_STATED","effective_text":{"text":"This section applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2020.","untrusted":true},"insulin_specific":true,"notes":[],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"18 Del. C. 3344B","untrusted":true},"quote":{"text":"Cap the total amount that a covered individual is required to pay for covered prescription insulin drugs at no more than $100 per month for each enrolled individual","untrusted":true}},{"state":"KY","source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=51776","read_on":"2026-11-07T07:47:34.776Z","proof_state":"verified","fact_id":"540bf3cad82a5f86ea1a71f0","cap_usd":30,"per":"30-day supply","plan_types":[{"text":"health benefit plans issued or renewed on or after January 1, 2022","untrusted":true}],"effective":"2022-01-01","effective_text":{"text":"Effective: January 1, 2022","untrusted":true},"insulin_specific":true,"notes":[],"scope_limit":null,"excludes":[{"text":"self-insured governmental plans (except as provided in KRS 18A.225)","untrusted":true}],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"KRS 304.17A-148(3)(b)","untrusted":true},"quote":{"text":"Cost sharing for a covered prescription insulin drug shall not exceed thirty dollars ($30) per thirty (30) day supply of each prescription insulin drug","untrusted":true}},{"state":"LA","source_url":"https://www.legis.la.gov/legis/Law.aspx?d=1296615","read_on":"2026-11-07T07:52:11.503Z","proof_state":"verified","fact_id":"56de00d27610d2700866624c","cap_usd":75,"per":"prescription for a thirty-day supply","plan_types":[{"text":"health coverage plan, defined to include group insurance plans, self-insurance plans and the Office of Group Benefits programs","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":true,"notes":["The cap rises each year with a price index."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"La. R.S. 22:1034.1(B)","untrusted":true},"quote":{"text":"A health coverage plan shall not impose a cost-sharing provision for insulin in the health coverage plan's formulary as prescribed in Subsection C of this Section if the total amount the enrollee is required to pay exceeds seventy-five dollars per prescription for a thirty-day supply, regardless of the amount or type of insulin needed to fill the enrollee's prescription.","untrusted":true}},{"state":"MA","source_url":"https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter176A/Section8DDD","read_on":"2026-11-07T07:52:16.066Z","proof_state":"verified","fact_id":"e067173bac6cf1738e37c884","cap_usd":25,"per":"30-day supply","plan_types":[{"text":"individual or group hospital service plan contracts (M.G.L. c. 176A s. 8DDD)","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":true,"notes":["The statute also bars a deductible for this coverage."],"scope_limit":{"text":"one brand name insulin drug per dosage and type","untrusted":true},"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"M.G.L. c. 176A s. 8DDD(d)","untrusted":true},"quote":{"text":"Coverage for 1 brand name insulin drug per dosage and type, including rapid-acting, short-acting, intermediate-acting, long-acting, ultra long-acting and premixed under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30-day supply.","untrusted":true}},{"state":"MD","source_url":"https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin&section=15-822.1&enactments=false","read_on":"2026-11-07T07:47:04.353Z","proof_state":"verified","fact_id":"5aa23efb65e440beadbba6a2","cap_usd":30,"per":"30-day supply","plan_types":[{"text":"insurers and nonprofit health service plans (individual or group policies delivered in the State)","untrusted":true},{"text":"health maintenance organizations (contracts issued or delivered in the State)","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":true,"notes":[],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"Md. Code, Insurance 15-822.1(b)","untrusted":true},"quote":{"text":"An entity subject to this section shall limit the amount a covered individual is required to pay in copayments or coinsurance for a covered prescription insulin drug to not more than $30 for a 30-day supply, regardless of the amount or type of insulin needed to fill the covered individual's prescription","untrusted":true}},{"state":"ME","source_url":"https://legislature.maine.gov/statutes/24-A/title24-Asec4317-C.html","read_on":"2026-11-07T07:44:38.671Z","proof_state":"verified","fact_id":"68d5c45eadfa60372fca94da","cap_usd":35,"per":"prescription for a 30-day supply","plan_types":[{"text":"coverage provided by a carrier for prescription insulin drugs","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":true,"notes":[],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"24-A M.R.S. 4317-C(2)","untrusted":true},"quote":{"text":"A carrier that provides coverage for prescription insulin drugs may not impose any deductible, copayment, coinsurance or other cost-sharing requirement on an enrollee for that coverage that results in out-of-pocket costs to the enrollee that exceed $35 per prescription for a 30-day supply of covered prescription insulin drugs","untrusted":true}},{"state":"MN","source_url":"https://www.revisor.mn.gov/statutes/cite/62Q.481","read_on":"2026-11-07T07:44:43.220Z","proof_state":"verified","fact_id":"a9585e81bb7571e8168900a3","cap_usd":25,"per":"one-month supply","plan_types":[{"text":"health plan","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":false,"notes":["This statute caps prescription drugs for chronic disease generally, not insulin alone."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":50,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"Minn. Stat. 62Q.481","untrusted":true},"quote":{"text":"A health plan must limit the amount of any enrollee cost-sharing for prescription drugs prescribed to treat a chronic disease to no more than: (1) $25 per one-month supply for each prescription drug, regardless of the amount or type of medication required to fill the prescription","untrusted":true}},{"state":"NH","source_url":"https://gc.nh.gov/rsa/html/XXXVII/415/415-6-e.htm","read_on":"2026-11-07T07:47:00.024Z","proof_state":"verified","fact_id":"7ae2fbf227605707b07761b3","cap_usd":30,"per":"30-day supply","plan_types":[{"text":"insurer that provides coverage for prescription insulin drugs (RSA 415:6-e)","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":true,"notes":[],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"RSA 415:6-e","untrusted":true},"quote":{"text":"Each insurer that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription","untrusted":true}},{"state":"NJ","source_url":"https://www.nj.gov/treasury/pensions/documents/laws/ch105-2023.pdf","read_on":"2026-11-07T07:47:26.799Z","proof_state":"verified","fact_id":"9ec02c60a036c905b53efe5b","cap_usd":35,"per":"30-day supply","plan_types":[{"text":"individual health benefits plan (C.17B:27A-7.31)","untrusted":true},{"text":"small employer health benefits plan (C.17B:27A-19.35)","untrusted":true},{"text":"State Health Benefits Commission contracts (C.52:14-17.29kk)","untrusted":true},{"text":"other individual and group contract types amended by the same act","untrusted":true}],"effective":"NOT_STATED","effective_text":{"text":"This act shall take effect on the first day of the seventh month next following the date of enactment and shall apply to plans issued or renewed on or after January 1 of the next calendar year","untrusted":true},"insulin_specific":true,"notes":["The statute also bars a deductible for this coverage."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"session law as enacted","untrusted":true},"cite":{"text":"P.L. 2023, c. 105","untrusted":true},"quote":{"text":"Coverage for the purchase of a shortacting, intermediate-acting, rapid-acting, long-acting, and pre-mixed insulin product shall not be subject to any deductible, and no copayment or coinsurance for the purchase of insulin shall exceed $35 per 30-day supply","untrusted":true}},{"state":"NV","source_url":"https://www.leg.state.nv.us/division/legal/lawlibrary/nrs/NRS-689A.html","read_on":"2026-11-07T07:45:51.615Z","proof_state":"verified","fact_id":"acbf83b0a06eaf76e09e42de","cap_usd":35,"per":"30-day supply","plan_types":[{"text":"policy of health insurance offered or issued by an insurer (NRS chapter 689A)","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":true,"notes":[],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"NRS 689A.040485","untrusted":true},"quote":{"text":"An insurer that offers or issues a policy of health insurance which provides coverage for prescription insulin drugs shall not impose against an insured a deductible, copayment, coinsurance or other cost-sharing obligation that is greater than $35 for a 30-day supply of a prescription insulin drug","untrusted":true}},{"state":"OR","source_url":"https://www.oregonlegislature.gov/bills_laws/ors/ors743a.html","read_on":"2026-11-07T07:47:13.204Z","proof_state":"verified","fact_id":"b5ad874385f1180e032b46a5","cap_usd":35,"per":"30-day supply","plan_types":[{"text":"health benefit plan offered in this state (ORS 743B.005)","untrusted":true}],"effective":"NOT_STATED","effective_text":null,"insulin_specific":true,"notes":["The statute also bars a deductible for this coverage."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":105,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"ORS 743A.069(2)","untrusted":true},"quote":{"text":"A health benefit plan offered in this state may not require an enrollee in the plan to incur cost-sharing or other out-of-pocket costs that exceed $35 for each 30-day supply of a type of insulin prescribed for the treatment of diabetes or $105 for each 90-day supply.","untrusted":true}},{"state":"RI","source_url":"https://webserver.rilegislature.gov/Statutes/TITLE27/27-20.8/27-20.8-3.htm","read_on":"2026-11-07T07:47:18.184Z","proof_state":"verified","fact_id":"46469381d68b4ea189b41e48","cap_usd":40,"per":"30-day supply","plan_types":[{"text":"health plan that provides coverage for prescription insulin drugs","untrusted":true}],"effective":"2022-01-01","effective_text":{"text":"History of Section: P.L. 2021, ch. 110, § 1, effective January 1, 2022; P.L. 2021, ch. 163, § 1, effective January 1, 2022.","untrusted":true},"insulin_specific":true,"notes":["The statute also bars a deductible for this coverage."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"R.I. Gen. Laws 27-20.8-3(b)","untrusted":true},"quote":{"text":"shall cap the total amount that a covered person is required to pay for a covered prescription insulin drug at an amount not to exceed forty dollars ($40.00), per thirty-day (30) supply of insulin","untrusted":true}},{"state":"VA","source_url":"https://law.lis.virginia.gov/vacode/38.2-3407.15:5","read_on":"2026-11-07T07:44:29.336Z","proof_state":"verified","fact_id":"cf138ea960354f0e25503ffa","cap_usd":35,"per":"30-day supply","plan_types":[{"text":"every health plan offered by a carrier (health benefit plan as defined in 38.2-3438)","untrusted":true}],"effective":"NOT_STATED","effective_text":{"text":"This section shall apply with respect to health plans and provider contracts entered into, amended, extended, or renewed on or after January 1, 2021.","untrusted":true},"insulin_specific":true,"notes":["The cap applies in aggregate when a person is prescribed more than one insulin drug."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"Va. Code 38.2-3407.15:5","untrusted":true},"quote":{"text":"Every health plan offered by a carrier shall set the cost-sharing payment that a covered person is required to pay for a covered prescription insulin drug at an amount that does not exceed $35 in aggregate, including situations where the covered person is prescribed more than one insulin drug, per 30-day supply of the prescription insulin drug","untrusted":true}},{"state":"WA","source_url":"https://lawfilesext.leg.wa.gov/law/RCWPDF/RCW%20%2048%20%20TITLE/RCW%20%2048%20.%2043%20%20CHAPTER/RCW%20%2048%20.%2043%20.780.pdf","read_on":"2026-11-07T07:46:54.392Z","proof_state":"verified","fact_id":"4b2e1acfc512665b65b09e21","cap_usd":35,"per":"30-day supply","plan_types":[{"text":"health plan issued or renewed","untrusted":true}],"effective":"2023-01-01","effective_text":{"text":"a health plan issued or renewed on or after January 1, 2023","untrusted":true},"insulin_specific":true,"notes":["The statute also bars a deductible for this coverage."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":null,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"RCW 48.43.780(1)(a)","untrusted":true},"quote":{"text":"a health plan issued or renewed on or after January 1, 2023, that provides coverage for prescription insulin drugs for the treatment of diabetes must cap the total amount that an enrollee is required to pay for a covered insulin drug at an amount not to exceed $35 per 30-day supply of the drug","untrusted":true}},{"state":"WV","source_url":"https://code.wvlegislature.gov/33-59-1/","read_on":"2026-11-07T07:44:51.901Z","proof_state":"verified","fact_id":"1c11333231f1b99d2763fece","cap_usd":35,"per":"30-day supply","plan_types":[{"text":"insurers subject to W. Va. Code 33-15, 33-16, 33-24, 33-25 and 33-25A, as the section cites them","untrusted":true}],"effective":"NOT_STATED","effective_text":{"text":"an insurer subject to [those chapters] ... which issues or renews a health insurance policy on or after January 1, 2023, shall provide coverage for prescription insulin drugs and equipment pursuant to this section","untrusted":true},"insulin_specific":true,"notes":["The cap applies in aggregate when a person is prescribed more than one insulin drug."],"scope_limit":null,"excludes":[],"cap_usd_per_90_day":null,"related_supplies_cap_usd_per_month":null,"related_devices_cap_usd":100,"source_kind":{"text":"current codified statute","untrusted":true},"cite":{"text":"W. Va. Code 33-59-1(e)","untrusted":true},"quote":{"text":"Cost sharing for a 30-day supply of a covered prescription insulin drug may not exceed $35 in aggregate, including situations where the covered person is prescribed more than one insulin drug, per 30-day supply","untrusted":true}}]},"receipts":[{"fact_id":"62f4a600a9318826a30279ee","field":"state.insulin_cap","entity":"state:CO"},{"fact_id":"720d31a1913da74720d6deb4","field":"state.insulin_cap","entity":"state:DE"},{"fact_id":"540bf3cad82a5f86ea1a71f0","field":"state.insulin_cap","entity":"state:KY"},{"fact_id":"56de00d27610d2700866624c","field":"state.insulin_cap","entity":"state:LA"},{"fact_id":"e067173bac6cf1738e37c884","field":"state.insulin_cap","entity":"state:MA"},{"fact_id":"5aa23efb65e440beadbba6a2","field":"state.insulin_cap","entity":"state:MD"},{"fact_id":"68d5c45eadfa60372fca94da","field":"state.insulin_cap","entity":"state:ME"},{"fact_id":"a9585e81bb7571e8168900a3","field":"state.insulin_cap","entity":"state:MN"},{"fact_id":"7ae2fbf227605707b07761b3","field":"state.insulin_cap","entity":"state:NH"},{"fact_id":"9ec02c60a036c905b53efe5b","field":"state.insulin_cap","entity":"state:NJ"},{"fact_id":"acbf83b0a06eaf76e09e42de","field":"state.insulin_cap","entity":"state:NV"},{"fact_id":"b5ad874385f1180e032b46a5","field":"state.insulin_cap","entity":"state:OR"},{"fact_id":"46469381d68b4ea189b41e48","field":"state.insulin_cap","entity":"state:RI"},{"fact_id":"cf138ea960354f0e25503ffa","field":"state.insulin_cap","entity":"state:VA"},{"fact_id":"4b2e1acfc512665b65b09e21","field":"state.insulin_cap","entity":"state:WA"},{"fact_id":"1c11333231f1b99d2763fece","field":"state.insulin_cap","entity":"state:WV"}],"as_of":{"newest_fact_retrieved_at":"2026-11-10T20:02:39.475Z"},"edition":{"id":"2026-11","merkleRoot":"006ab9a329709cbe7f56a0e1a7c4a02f897655cdfecf9ca34d199690095adcb6","factCount":212100,"manifestPresent":true},"licence":{"classes":["GREEN"],"note":"Source records are public; this compilation is cited with attribution. See the provenance tool for each fact's licence label."},"unknown":[{"code":"NO_DATA","field":"states_not_listed","reason":"a state missing from this file is UNREAD by us, not a state without a law or program; absence here is not a claim about the state"}],"disclaimer":"OmniRx is a reference layer of dated public facts, not clinical advice and not a guarantee of price, coverage or eligibility. Each answer lists the facts it rests on."}