I’ve been part of conversations about insulin affordability in Wisconsin for a long time—long enough to know that change in healthcare policy rarely moves quickly.

In 2019, after a Wisconsin insulin price cap bill was proposed, I started a Change.org petition urging lawmakers to act. That petition ultimately gathered more than 62,000 supporters. It led to an invitation to a Change.org All Team Retreat, where I spoke about the importance of making insulin—a life-saving, non-negotiable medication—more affordable and accessible.

That bill didn’t pass.

Now, several years later, Wisconsin lawmakers are once again considering insulin affordability legislation—this time in the form of a proposed insulin copay cap set to take effect in 2026 if passed. While the details differ, the core issue remains the same: how do we reduce the financial burden of insulin in a healthcare system that often leaves people navigating complexity alone?

This article outlines the proposed legislation and its role within the broader, flawed landscape of insulin access in the U.S., incorporating facts, context, and personal experiences.

What Is an Insulin Copay Cap?

An insulin copay cap is a law that limits how much an insured person must pay out of pocket for insulin over a set period, typically per month. Importantly, these caps apply to cost-sharing, not the insulin’s list price.

That distinction matters.

Copay caps do not regulate what manufacturers charge, how pharmacy benefit managers (PBMs) negotiate prices, or how insurers structure formularies. Instead, they limit what the patient pays at the pharmacy counter when covered by a qualifying insurance plan.

Limited insulin copay caps apply to uninsured or underinsured individuals.

As of early 2026, 29 states have enacted some form of insulin copay cap, with limits commonly ranging from $25 to $100 per month. Wisconsin’s proposal would place that limit at $35 for a one-month supply.

What the Wisconsin Proposal Would Do

If passed, Wisconsin’s proposed legislation would cap insulin cost-sharing at $35 for a one-month supply for individuals with state-regulated insurance plans.

In practical terms, this means:

• The cap applies to insured individuals

• It limits out-of-pocket costs, not list prices

• It mirrors the $35 insulin cap already in place for Medicare beneficiaries

• It applies only to plans regulated at the state level

This places Wisconsin in step with a national trend toward state-level insulin cost controls, particularly in the absence of comprehensive federal reform.

Who These Caps Help—and Why That Matters

For people who are insured and face high insulin copays or coinsurance, a monthly cap can provide something often missing in diabetes care: stability.

Living with insulin-dependent diabetes involves continuous calculation. Dosages vary, needs fluctuate, supplies differ, and expenses shift. A cap won't remove these challenges, but it can lessen a significant factor, allowing insured individuals with insulin-dependent diabetes to prioritize their health and place costs lower on their list of concerns.

Research consistently shows that lower out-of-pocket insulin costs are associated with improved diabetes management. When insulin is more affordable, people are less likely to delay refills, ration doses, or stretch supplies. This stresses the fact that insulin copay price caps don't matter just financially, but medically as well.

For many insured individuals, insulin copay caps represent meaningful progress.

The Limits of a “$35 Per Month” Headline

Where insulin copay caps can become confusing—and sometimes misleading—is in how they are discussed.

From what I understand, the proposed Wisconsin cap applies to a one-month supply per prescription. In practice, many people require more than one type of insulin. Some use both long-acting and rapid-acting insulin. Others switch formulations or brands based on availability, insurance coverage, or clinical needs.

Depending on how prescriptions and insurance plans are structured, costs can still add up.

And insulin is rarely the only expense. Diabetes management often includes continuous glucose monitors (CGMs), insulin pumps, infusion sets, sensors, test strips, and, in some cases, additional medications. Insulin copay caps do not address those costs.

So while $35 sounds simple—and can be helpful—it doesn’t represent the full financial picture for many people living with diabetes.

Who These Laws Don’t Reach

One of the hardest truths about insulin copay caps is also one of the most important: they do not help everyone who needs insulin.

These laws generally do not apply to:

• Uninsured individuals

• People with self-funded employer insurance plans

• Those whose barriers are not primarily cost-related

For people who are uninsured or underinsured, insulin affordability remains a daily challenge shaped by a patchwork of assistance programs, discount cards, emergency supplies, and personal sacrifice.

Acknowledging this gap isn’t meant to diminish the value of copay caps—it’s meant to keep the conversation honest.

Copay Caps vs. Assistance Programs

In the U.S., insulin affordability currently relies on a mix of approaches: manufacturer copay cards, patient assistance programs, nonprofit aid, and legislation.

One key difference between legislation and assistance programs is stability.

Assistance programs can change eligibility rules, funding levels, or availability with little notice. They often require paperwork, renewals, and ongoing verification. For some people, they are lifesaving. For others, they are inaccessible.

Once enacted, state laws tend to be more durable. They don’t require reapplication. They apply broadly within their scope. And while laws can change, they are generally harder to dismantle than voluntary programs.

This is one reason many advocates see copay caps as a meaningful—though incomplete—step forward.

Why State-Level Action Still Matters

In an ideal world, insulin affordability would be addressed comprehensively at the federal level. Until that happens, states are where much of the action is.

State-level insulin copay caps:

• Reflect growing recognition of insulin as an essential medication

• Respond to constituent experiences

• Create policy models that may inform future reform

• Normalize the idea that access to insulin is a public health issue

At the same time, they also highlight how fragmented the U.S. healthcare system remains, especially for people whose insurance falls outside state jurisdiction.

Both realities can exist at once.

Progress and Perspective

I don’t see insulin copay caps as a finish line. I see them as a mile marker.

They reduce concerns for some people. They bring relief to many. They also leave gaps that deserve continued attention, particularly for uninsured and underinsured communities.

It is possible—and necessary—to recognize progress while still naming what remains unresolved.

I’m grateful that Wisconsin lawmakers are considering this legislation again. I’m hopeful it moves forward. And I remain clear-eyed about what it can and cannot do.

No one should have to choose between insulin, groceries, and housing. And yet, even in 2026, people still do.

Understanding the nuance of policies like insulin copay caps helps us move the conversation forward with clarity.

Disclosures

This article reflects the author’s personal experience and analysis and is intended for educational and informational purposes only. It does not constitute medical advice, legal advice, or policy guidance. The author is not a healthcare provider, attorney, or legislator. Individuals should consult qualified professionals regarding medical treatment, insurance coverage, or legal matters.

References

• American Diabetes Association. (n.d.). State insulin copay caps. https://diabetes.org/tools-resources/affordable-insulin/state-insulin-copay-caps

• Centers for Medicare & Medicaid Services. (2023). Insulin cost-sharing under the Inflation Reduction Act. https://www.cms.gov/inflation-reduction-act-and-medicare/insulin

• Kaiser Family Foundation. (2023). The facts about the $35 insulin copay cap in Medicare. https://www.kff.org/medicare/the-facts-about-the-35-insulin-copay-cap-in-medicare/

• National Conference of State Legislatures. (2024). Improving access and affordability of insulin and diabetic supplies. https://www.ncsl.org/health/improving-access-and-affordability-of-insulin-and-diabetic-supplies

• National Conference of State Legislatures. (2024). Prescription drug legislation aimed at reducing consumer costs. https://www.ncsl.org/resources/details/this-years-prescription-drug-bills-aim-to-reduce-consumer-costs

• WEAU News. (2026, January 19). Western Wisconsin lawmakers propose bill to cap insulin costs. https://www.weau.com/2026/01/19/western-wisconsin-lawmakers-propose-bill-cap-insulin-costs/

• WisPolitics. (2026). Rep. Billings, Sen. Pfaff introduce legislation to cap the price of insulin. https://www.wispolitics.com/2026/rep-billings-sen-pfaff-introduce-legislation-to-cap-the-price-of-insulin/