Insulin Copay Caps and School Glucagon Laws, State by State

Key Findings

1. 29 states and DC cap what insured patients pay for insulin. Caps range from $0 (New York) to $100 a month; 24 are at $35 or less.
2. The biggest gap isn't geographic. State caps apply to state-regulated insurance. Self-funded employer plans — which cover 67% of workers with job-based coverage, and 80% at firms with 200 or more workers — are regulated federally and are generally exempt. A child covered through a parent's large employer may not benefit from the state cap at all.
3. Only 11 states and DC have laws letting schools stock "undesignated" glucagon — emergency glucagon that isn't prescribed to one specific student, so it's available even if a child's own kit is missing or expired.
4. 6 jurisdictions have both protections: District of Columbia, Illinois, Kentucky, Maine, Oklahoma, Virginia. 15 states have neither.
5. A few states go beyond insulin. Connecticut, Delaware, DC, Minnesota, North Dakota, Virginia and West Virginia also limit costs for some diabetes devices or supplies; Delaware sets insulin pump cost-sharing at $0.

How State Insulin Caps Compare

Number of jurisdictions at each monthly cap amount (30-day supply).

The State-by-State Table

Type a state to filter. "No state cap" doesn't mean insulin is unaffordable — many plans and manufacturer programs have their own limits — only that state law doesn't set one.

What This Means for Families

Find out how your plan is funded

The single most useful question to ask your employer's HR or benefits team is: "Is our health plan fully insured or self-funded?" If it's fully insured and sold in your state, the state cap should apply. If it's self-funded, the cap generally doesn't — though some employers voluntarily match it. ACA marketplace plans bought in your state are state-regulated.

Medicare's $35 cap doesn't cover children

The federal $35-a-month insulin cap from the Inflation Reduction Act applies to Medicare. Children are covered through private insurance, Medicaid or CHIP instead, so the federal cap rarely helps them directly.

Glucagon at school

Even where a state has no stock-glucagon law, your child can — and should — have their own prescribed glucagon at school under their Diabetes Medical Management Plan. Rules on which school staff may give insulin and glucagon also vary by state; the American Diabetes Association's Safe at School state map shows them. Federal law (Section 504 and the ADA) applies in every state — see our 504 plan guide.

Methodology and Limitations

Insulin cap data comes from the American Diabetes Association's state insulin copay cap tracker (most recent map update October 2025); school glucagon data comes from the ADA's "States with Undesignated Glucagon Laws" document (April 2026). We checked them on October 12, 2026, and confirmed that a proposed Wisconsin insulin cap (AB 921) failed in March 2026 and is not law. Laws change often and details matter: caps can differ by plan type, effective date and whether they apply per prescription or collectively. This report is not legal advice — confirm details with your state's insurance department or the ADA (1-800-DIABETES). Self-funded plan figures come from the KFF 2025 Employer Health Benefits Survey.

Sources

1. American Diabetes Association. State Insulin Copay Caps.
2. American Diabetes Association. States with Undesignated Glucagon Laws (PDF), April 2026.
3. KFF. 2025 Employer Health Benefits Survey.
4. Wisconsin State Legislature. AB 921 (2025–2026), status via LegiScan.

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