What Diabetes Medications Are Covered by Medicare?

Managing diabetes can be expensive, but Medicare provides comprehensive coverage for diabetes medications that can significantly reduce your out-of-pocket costs.

Understanding which medications are covered and how Medicare works can help you make informed decisions about your diabetes treatment while keeping costs manageable.

Beyond insulin, several other injectable diabetes medications have become important treatment options, each with distinct coverage considerations under Medicare plans.

Does Medicare Cover Diabetes Medication?

Medicare covers diabetes medications through different parts of the program, primarily Medicare Part B and Part D.

The coverage includes both insulin and non-insulin diabetes medications, with recent changes from the Inflation Reduction Act making diabetes treatment more affordable than ever before.

Medicare Part D: Primary Coverage for Diabetes Medications

Medicare Part D prescription drug plans serve as the primary coverage for most diabetes medications.

This includes standalone prescription drug plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MAPD). Part D covers a wide range of diabetes medications including insulin, oral medications, and newer injectable treatments.

Medicare Part B: Limited Diabetes Medication Coverage

Medicare Part B provides more limited coverage for diabetes medications, primarily covering insulin used with durable medical equipment like insulin pumps. Part B also covers diabetes supplies such as blood glucose monitors, test strips, and lancets.

Does Medicare Cover Insulin?

One of the most significant improvements in Medicare diabetes coverage is the insulin cost cap implemented through the Inflation Reduction Act.

$35 Monthly Insulin Cap

The most significant change for insulin users has been the implementation of monthly cost caps that provide predictable budgeting for this essential medication.

Starting in 2023, Medicare Part D enrollees pay no more than $35 per month for each insulin prescription, regardless of the insulin type or brand. This cap applies to all Medicare Part D plans and represents substantial savings for many beneficiaries who previously paid much higher costs for insulin.

Types of Insulin Covered

Beyond the cost protections, it's important to understand which specific insulin formulations are included in Medicare coverage.

Medicare Part D plans typically cover various types of insulin, including:

• Rapid-acting insulin (insulin aspart, insulin lispro, insulin glulisine)
• Short-acting insulin (regular human insulin)
• Intermediate-acting insulin (NPH insulin)
• Long-acting insulin (insulin glargine, insulin detemir, insulin degludec)
• Ultra-long-acting insulin (insulin degludec)
• Pre-mixed insulin combinations

Insulin Pump Coverage

For those who use insulin delivery devices, Medicare provides additional coverage options through a different part of the program.

For beneficiaries using insulin pumps, Medicare Part B may cover the insulin used with durable medical equipment. The specific coverage depends on your circumstances and medical necessity.

Oral Diabetes Medication Coverage and Costs

While insulin often receives the most attention in diabetes coverage discussions, oral medications form the foundation of treatment for many people with Type 2 diabetes and deserve careful consideration when evaluating Medicare plans.

Biguanides

Metformin is the most commonly prescribed medication in this class and is typically covered by most Medicare Part D plans. Metformin is often the first-line treatment for Type 2 diabetes and is usually available at lower cost tiers.

Sulfonylureas

These traditional diabetes medications have been helping patients manage blood sugar for decades and generally offer favorable coverage terms. This class of medications helps stimulate insulin production and includes drugs such as:

• Glipizide
• Glyburide
• Glimepiride

These medications are generally well-covered by Medicare Part D plans and are often available as generic options.

DPP-4 Inhibitors

Newer oral medications in the diabetes treatment arsenal may require additional consideration when selecting your Medicare plan.

These newer medications help regulate blood sugar levels and include:

• Sitagliptin (Januvia)
• Saxagliptin (Onglyza)
• Linagliptin (Tradjenta)

Coverage varies by plan, and these medications may require prior authorization or step therapy.

SGLT2 Inhibitors

This innovative class of oral diabetes medications works through a unique mechanism and has varying coverage across Medicare plans. These medications have been helpful and shown to also lower cardiovascular risks as well.

• Empagliflozin (Jardiance)
• Canagliflozin (Invokana)
• Dapagliflozin (Farxiga)

Coverage varies by plan, and some may require prior authorization.

Thiazolidinediones

While less commonly prescribed today, these medications remain an option for certain patients and maintain coverage under Medicare plans. This class includes medications like pioglitazone (Actos), which may be covered under Medicare Part D plans, though usage has declined due to safety considerations.

2025 Medicare Part D Changes Affecting Diabetes Medication Coverage

Recent legislative changes have brought about the most significant improvements to Medicare prescription drug coverage in the program's history, with particular benefits for people managing diabetes.

Several important changes took effect in 2025 that benefit people with diabetes:

$2,000 Out-of-Pocket Maximum

The most significant protection for all Medicare Part D enrollees is the new annual spending limit that provides peace of mind for those with high medication costs.

All Medicare Part D plans now feature a $2,000 maximum out-of-pocket cost for covered medications. Once you reach this limit, your plan pays 100% of covered drug costs for the remainder of the plan year. This change provides significant protection against high medication costs.

Improved Cost Structure

Beyond the spending cap, the overall structure of Medicare Part D has been redesigned to provide better financial protection throughout the coverage year.

The Medicare Part D benefit structure has been redesigned to provide better cost protection throughout the year, with changes to how costs are shared between beneficiaries, plans, and Medicare.

Factors Affecting Coverage and Costs

Understanding the various factors that influence your medication coverage and costs can help you make more informed decisions about your Medicare plan selection and diabetes management strategy.

Plan Formularies

The foundation of your medication coverage lies in your plan's drug list, which can significantly impact both availability and cost of your diabetes medications.

Each Medicare Part D plan maintains a formulary (list of covered drugs) that determines which specific medications are covered and at what cost level. Formularies can change annually, so it's important to review your plan's coverage during the annual Open Enrollment period.

Prior Authorization

Some medications require additional approval steps before coverage begins, which can affect your access to certain diabetes treatments.

Some diabetes medications may require prior authorization, meaning your doctor must demonstrate medical necessity before the medication is covered. This is more common with newer, brand-name medications.

Step Therapy

Many plans use a systematic approach that encourages trying less expensive medications before covering more costly alternatives.

Some plans use step therapy, requiring you to try less expensive medications before covering more costly options. Your doctor can request exceptions if medically necessary.

Generic vs. Brand Name

The choice between generic and brand-name medications can significantly impact your out-of-pocket costs throughout the year.

Generic versions of diabetes medications are typically covered at lower cost-sharing levels than brand-name drugs. When available, generics can provide significant savings.

Health Advocates in Diabetes Care

Navigating Medicare’s complex coverage options can be overwhelming, especially for those managing chronic conditions like diabetes. Health advocates—such as certified Community Health Workers, peer support specialists, and Medicare counselors—play a crucial role in helping beneficiaries:

• Interpret plan details and formularies
• Appeal coverage denials or navigate prior authorization
• Identify cost-saving opportunities, including Extra Help programs and mail-order pharmacy options
• Ensure continuity of care during plan changes or emergencies

Research shows that health advocates improve patient outcomes, reduce healthcare disparities, and help individuals access the resources they need for effective chronic disease management.

The Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) both emphasize the value of health advocates in supporting diabetes self-management and improving health equity. Feel free to reach out to Pinnie to discuss your support options.

Tips for Maximizing Your Diabetes Medication Coverage

Taking proactive steps to optimize your Medicare coverage can result in significant savings and better access to the diabetes medications you need.

Review Plans Annually

One of the most important steps you can take is staying current with Medicare plan changes and ensuring your coverage still meets your needs.

The Medicare landscape changes each year, making annual plan review essential for maintaining optimal coverage and costs.

During Medicare's Open Enrollment period (October 15 - December 7), review available Part D plans to ensure your current plan still offers the best coverage for your specific medications.

Consider Mail-Order Pharmacies

Beyond plan selection, the way you fill your prescriptions can also impact your overall medication costs.

Many Medicare plans offer additional savings opportunities through their preferred pharmacy networks and delivery options.

Many Medicare Part D plans offer lower costs when you use their preferred mail-order pharmacy for 90-day supplies of maintenance medications.

Work with Your Healthcare Provider

Your relationship with your healthcare team extends beyond medical treatment to include navigating insurance coverage and finding affordable solutions.

Collaboration with your medical team can help you navigate coverage challenges and find cost-effective treatment alternatives.

Maintain open communication with your healthcare provider about medication costs. They may be able to prescribe equally effective alternatives that are better covered by your plan.

Diabetes Supplies Coverage

In addition to medications, Medicare recognizes that effective diabetes management requires various testing supplies and monitoring equipment.

In addition to medications, Medicare Part B covers essential diabetes supplies:

• Blood glucose monitors
• Blood glucose test strips
• Lancet devices and lancets
• Glucose control solutions
• Insulin syringes and needles (when used with covered insulin)

Medicare typically pays 80% of the Medicare-approved amount for these supplies after you meet your Part B deductible.

Planning for Diabetes Care Costs

Effective financial planning for diabetes care involves understanding both immediate costs and long-term expenses associated with managing this chronic condition.

Understanding Your Total Costs

When evaluating Medicare plans, it's important to look beyond just monthly premiums to understand your complete financial picture.

Consider both premium costs and out-of-pocket expenses when selecting a Medicare Part D plan. A plan with a higher premium might offer better coverage for your specific medications, resulting in lower overall costs.

Budget for the Coverage Gap

Even with recent improvements to Medicare Part D, understanding how costs progress throughout the year remains important for financial planning.

While the 2025 changes have improved Part D coverage, understanding how costs progress throughout the year can help you budget effectively for your diabetes care.

Emergency Preparedness

Planning ahead for unexpected situations can help ensure the continuity of your diabetes care regardless of circumstances.

Ensure you have adequate supplies of your diabetes medications and consider how you'll access care during emergencies or when traveling.

Bottom Line

Medicare provides substantial coverage for diabetes medications through Part D plans, with recent improvements making treatment more affordable than ever. The $35 monthly insulin cap and $2,000 annual out-of-pocket maximum represent significant patient protections. However, coverage details vary between plans, making it essential to carefully evaluate your options during enrollment periods.

Working closely with your healthcare provider and staying informed about your Medicare benefits can help ensure you receive the diabetes care you need while managing costs effectively. For personalized assistance, contact your State Health Insurance Assistance Program (SHIP) or speak with a health advocate, like those at Pinnie to address your specific needs and optimize your Medicare coverage.