# Millions still can't afford insulin despite reforms > Despite price caps and policy changes, one in three Americans who need insulin still ration it due to cost. - Title: Millions still can't afford insulin despite reforms · Vox - Summary: Despite price caps and policy changes, one in three Americans who need insulin still ration it due to cost. Out-of-pocket caps helped some people, but… - Keywords: insulin, diabetes, drug prices, medicare, inflation reduction act, alec smith, t1 international, shaina kasper, kasia lipska, yale diabetes center, eli lilly, california - Source: Vox — https://vox.com/good-medicine-newsletter/503183/insulin-pen-syringe-diabetes-cost-price - Author: Dylan Scott - Published: 2026-09-17T20:00:00+00:00 - Read time: 3 min - Topics: insulin, diabetes, drug prices, medicare, inflation reduction act, alec smith, t1 international, shaina kasper, kasia lipska, yale diabetes center, eli lilly, california ## Insulin became a crisis symbol A decade ago, insulin became the poster child for America's out-of-control drug prices. Alec Smith's 2017 death while rationing insulin sparked outrage. ## Politicians passed price caps Starting in 2019, 27 states passed laws capping out-of-pocket costs. Congress added a $35 monthly cap for Medicare in 2022. ## The crisis isn't over Millions still struggle to pay for insulin and have their health at risk. Advocates blame pharmaceutical greed for ongoing problems. > There has been so much attention and promise to action around the insulin price crisis. … And shockingly, frustratingly, critically, the data from our 2024 survey showed that the rationing rates were worse than ever. ## One in three still ration A 2024 Yale study found 38% of patients still had trouble keeping insulin on hand. Nationwide, 34% of insulin users reported rationing. ## Rationing rates haven't improved Yale patients rationed insulin at the same rate in 2024 as in 2017, about one in four. About 8.4 million Americans rely on insulin. > I was surprised because I've been looking at the policy and advocating for policy change; you think things are moving, they should be really improving. ## Getting insulin is complicated It's not as simple as showing up at the pharmacy. Who's covered and how they access insulin is extremely complicated. ## Uninsured face discount nightmares Millions remain uninsured and must pay cash prices. Enrolling for drugmaker discount cards is a nightmare with many restrictions. ## Eli Lilly's promise fell short Despite Lilly's pledge of $25 vials, uninsured patients paid nearly $100 on average in 2023. Discounted versions are often out of stock. ## Federal cap excludes most people The $35 cap applies only to Medicare, not the private insurance covering half the country. Bills to extend it haven't advanced. ## State laws have loopholes State caps typically exclude larger self-funded plans. Around 775,000 people with private insurance were protected in 2025, but over 1 million weren't. ## Even $35 isn't always $35 Some struggle to afford $35 monthly. People need different amounts and types, and pharmacy substitutions can lead to higher costs. ## One patient paid $140 monthly Despite being on Medicare with a $35 cap, one of Dr. Lipska's patients ended up paying $140 per month for insulin. > These things really add up…and frustrate people, because what seems like a great idea is not actually how things work on the ground. ## Rationing causes serious harm Without enough insulin, blood sugar spikes can cause diabetic ketoacidosis, where your blood turns into acid. It feels like you're dying. ## Long-term rationing damages health Prolonged high blood sugar from rationing can lead to serious vision and nerve problems that insulin was supposed to prevent. ## Advocacy momentum has slowed The comprehensive insulin cap bill was delayed over a year this Congress. Advocates worry the issue has become less urgent. ## Public manufacturing is the answer Advocates are pushing for government to procure or produce insulin itself and make it available at the lowest possible cost. > This idea that medicines should be for people and not for profit I feel like is really catching. ## Oklahoma funds private production Oklahoma passed a bill offering government funding for private companies that pledge to produce insulin and sell it at low prices. ## California is making its own California launched a program to eventually produce insulin in government-owned facilities. It will take years before production begins. ## Public production solves shortages Only three insulin makers exist in the US. As they focus on GLP-1 production, nonprofit initiatives could fill supply gaps. > The general communication that we've been hearing is that the insulin price crisis is over. As the data shows, as we've been talking about, that is just not true. ## Key takeaway Out-of-pocket caps helped some people, but millions still can't afford insulin due to insurance gaps, complex discount programs, and loopholes in state and federal laws.