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Insulin Access Resource Guide

Working Artist

— 6 min read
Insulin Access Resource Guide

I. Why This Guide Exists 

The insulin crisis in the U.S. has created unnecessary barriers to survival. For uninsured, underinsured, or undocumented creatives, access to life-saving medication can feel impossible.

Working Artist, with contributions from T1International, created this resource to demystify insulin access and empower those navigating diabetes care because we believe every person deserves to live and create, free from medical crisis.

This is a living document and will be updated as legislation, resources, and lived realities shift. 

II. Insulin Basics

  • What Is Insulin?Insulin is a hormone that regulates blood sugar levels. People with Type 1 diabetes must take insulin to survive. Without insulin, our bodies cannot convert glucose into energy, which can lead to life-threatening complications.
  • Who Needs Insulin?
    • People with Type 1 diabetes
    • Some people with Type 2 diabetes
    • People with gestational diabetes
    • People with other conditions impacting insulin production
  • Types of Insulin & Delivery Methods:
Chart provided by CDC.gov
  • Delivery options:
    • Vial & syringe
    • Insulin pens
    • Tubed insulin pumps
    • Tubeless pumps (e.g., Omnipod)
    • Newer tech: closed-loop systems, smart pens

III. Who Produces and Sells Insulin

The “Big Three” Manufacturers:

  • Eli Lilly
  • Novo Nordisk
  • Sanofi

These companies have historically dominated the U.S. market. They currently control over 90% of the market. This degree of market control allows them to set high prices.

Newer Generics & Biosimilars:

  • Insulin glargine (generic for Lantus)
  • Insulin lispro (generic for Humalog)
  • A note: both of these biosimilars are produced by Eli Lilly – one of the big three insulin manufacturers. This limits the amount of competition that they actually bring to the market.   

IV. Cost & Coverage

Without Insurance:

  • Insulin can cost $100 to $500+ per month if you’re paying out of pocket
  • Some lower-cost options exist:
    • Walmart’s ReliOn insulin: ~$25/vial (older formulations, but a lifeline in emergencies)
    • GoodRx and Mark Cuban’s Cost Plus Drugs can help you find better prices

With Insurance:

  • Private insurance: Copays can vary based on your plan and which insulins are “preferred”
  • Medicaid: Covers insulin, though you may need prior authorization or to follow step therapy rules
  • Medicare (Part D): Insulin is covered with a monthly copay limit, but it’s important to check your plan’s formulary
  • If your insulin isn’t covered:
    • You can appeal!
    • Ask your doctor to write a medical necessity letter. Request a formulary exception.

In New York State:

  • New York state passed a ban on insulin copays for people on state-regulated insurance plans
    • Though the plan is supposed to mean insulin is free for people on state-regulated insurance plans upon pick up at the pharmacy, community members have experienced a variety of prices. 
  • Who qualifies?
    • Anyone on a state-regulated health insurance plan, such as open market exchange plans or Medicaid
    • If you have private insurance (not a federal plan like Medicare), this law likely does not apply
    • Still being charged more? Contact the NYS Department of Financial Services or reach out to your T1 International NY Chapter for help navigating.

If You’re Undocumented or Not a U.S. Citizen:

  • You still have options:
    • Undocumented people in New York can qualify for some state healthcare plans
    • New York City also provides other low/no cost healthcare options for undocumented New Yorkers
    • Community health clinics offer insulin at reduced or no cost, regardless of immigration status.
    • Federally Qualified Health Centers (FQHCs) provide sliding-scale careOrganizations like Callen-Lorde, Apicha Community Health Center, and Mixteca in NYC support immigrant and LGBTQ+ health access
    • No ID? No problem—some clinics accept walk-ins without documentation

V. How to Access Insulin

  • Traditional Access Points:
    • Doctor’s prescription → pharmacy
    • Building a care plan with an endocrinologist can help you access the right type of insulin + supplies consistently.
  • Alternative or Emergency Options:
    • Of Note: If you are a student or gig worker with irregular income, you can submit recent pay stubs, a letter of support, or an explanation of financial hardship.
    • Patient Assistance Programs (PAPs) from:
      • Lilly Cares
        • Covers: Humalog, Basaglar, Humulin
        • Income limit: at or below 400% of the Federal Poverty Level (FPL) - about $60,240 per year for a single person or $124,800 per year of family of four
        • Apply here
      • NovoCare
        • Covers: Novolog, Fiasp, Tresibaa
        • Income limit: at or below 400% of the Federal Poverty Level (FPL) - about $60,240 per year for a single person or $124,800 per year of family of four
        • Apply here
      • Sanofi Patient Connection
        • Covers: Lantus, Adipra, Toujeo
        • Income limit: at or below 400% of the Federal Poverty Level (FPL) - about $60,240 per year for a single person or $124,800 per year of family of four
        • Must be uninsured or underinsured
        • Apply here
    • Online tools:
    • Mutual aid and insulin-sharing networks, like Mutual Aid Diabetes
    • Free clinics and Federally Qualified Health Centers (FQHCs)
  • How to Talk to a Pharmacist or Doctor:
    • Sample Script (for affordability): "Hi, I’m trying to afford my insulin this month—are there any generics, samples, or discount options you recommend?"
    • Sample Script (for options): "I’ve heard of ReliOn or other low-cost insulins. Can we talk about whether that’s safe for me?"

VI. Emergency Planning

  • What to Do in a Diabetic Emergency:
    • Recognizing signs of DKA or severe hypoglycemia
      • DKA warning signs: nausea, vomiting, fruity breath, fast breathing, confusion.
      • Severe low blood sugar: shaking, sweating, dizziness, passing out.
    • When to go to the ER or call 911
    • What to say if you're worried about cost at the hospital
      • "I’m uninsured and worried about cost. Can you connect me with a social worker or financial counselor?"
      • The Patient Advocate Foundation’s guide to your rights as an uninsured patient can be found here
        • Please note that hospitals must treat you in an emergency regardless of whether or not you are insured
  • Emergency Kits & Prep:
    • Keep extra insulin, needles, snacks, and glucose tabs in your bag at all times (highly, highly recommend - cannot count the number of times we’ve been stuck in a pinch because we forgot to do this)
    • Store backup insulin in:
      • Frio cooling pouches
      • Mini fridges at places of work, studios, friend, family member, or partner’s houses
    • For travel or heat waves: use ice packs, insulin pens

VII. Intersectional Access Barriers

  • For Trans/Nonbinary Individuals:
    • If your ID/name doesn’t match your prescription, ask your doctor/pharmacist for help—many are trained in trans-affirming care.
    • Report discrimination or denial of service to LGBTQ+ health orgs or legal aid groups like Trans Health Project.
  • For Creatives Experiencing Housing Insecurity:
    • Look into mail-order prescriptions to safe addresses such a friend, family-member, or partners’ home or pick up from local clinics
      • Mail delivery pharmacies: ExpressScripts, CVS Caremark, OptumRX
    • Insulin storage tips
      • Use insulated bags or frio packs
      • Keep insulin out of extreme heat or cold (under your clothes or blankets in winter, in shaded areas in summer)
  • Racial & Socioeconomic Disparities:
    • Black, Brown, and low-income communities are diagnosed later, receive less support, and face more complications.
    • Health equity means fighting for systemic change, not just coupons.
    • T1International and mutual aid networks center lived experience and advocacy by those most impacted.

VIII. Policy & Advocacy

  • Current Legislation:
    • On a federal level: 
    • State-by-state policy (focus on New York)
      • The New York Affordable Drug Manufacturing Act, aka public pharma, a historic piece of legislation which would enable the state to start manufacturing its own insulin that would be sold to New Yorkers at low or no cost. 
      • The Emergency Insulin Program, a bill that would ensure that anyone with a valid insulin prescription can go to the pharmacy and pick up an emergency 30-day supply of insulin once-per-year regardless of their ability to pay. This lifesaving legislation has been passed in four other states and is a critical measure to stop life threatening insulin rationing.
  • Aspirational Advocacy Goals:
    • Universal healthcare and true affordability
    • Public manufacturing aka public pharma
    • A fully functioning insulin safety net to end insulin rationing
  • How to Support the Movement:
    • Donate to or volunteer with:
  • How to Get Involved with T1International:

IX. Supporting Friends with Diabetes

  • What Allies Can Do:
    • Normalize insulin use and diabetes visibility
    • Offer practical help (rides, reminders, snacks)
    • Advocate for access, not charity
    • If you see someone exhibiting signs of low blood sugar (sweatiness, nausea, disorientation) they need glucose ASAP. Foods high in sugar such as juice, soda, and candy are ideal to treat low blood sugar or glycemic episodes. 

X. Final Words

  • Living with diabetes shouldn't mean navigating crisis after crisis.
  • Creative workers deserve healthcare—and insulin—that supports their lives and their art
  • We're here to help!!!!!

Sources

(Last updated June 2025)

Insulin Basics

Who Produces and Sells Insulin

General Cost & Coverage:

Patient Assistance Programs:

New York State Copay Cap:

Emergency Access & Online Tools:

Emergency Preparedness:

Intersectional Access Barriers:

Policy & Advocacy:

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