Insulin Affordability Program
HB21-1307 & Emergency and 12-Month Insulin Supply
The Insulin Affordability Program was created by HB21-1307 (Prescription Insulin Pricing and Access). Beginning January 1, 2022, eligible individuals can receive a 12-month prescription for insulin for no more than a $50 copay for a 30-day supply and an emergency 30-day supply of insulin once per 12-month period for no more than a $35 copay. The law directs the Division to create an application for the program.
The program will go into effect January 1, 2022.
Insulin Affordability Program for Emergency and 12-Month Insulin Supply Application
Who qualifies for the Insulin Affordability Program?
To be eligible for this program you must:
- Be a resident of Colorado
- Have a current prescription for insulin
- Pay more than $100 for a 30-day supply for your insulin
- Present identification proving Colorado residency including, but not limited to, a valid Colorado identification card, driver's license or permit, or tribal-issued identification. If you are a minor under the age of 18, your parent or legal guardian must provide proof of residency.
Emergency 30-Day Supply of Insulin -- If you are seeking an emergency 30-day supply of insulin, you must:
- Have an emergency need for insulin
- Have less than a 7-day supply of insulin available
If you qualify for an emergency supply of insulin, you may pay a $35 co-pay to receive a 30-day supply. You can only access an emergency supply of insulin once in a 12-month period.
12-Month Supply of Insulin -- If you are seeking an affordable 12-month supply of insulin:
- You cannot be enrolled in or eligible for Colorado Medicaid (also known as Health First Colorado)
- You cannot be enrolled in or eligible for Medicare
If you qualify for a 12-month supply of insulin, you may pay a $50 co-pay for each 30-day supply.
You may qualify for a manufacturer's patient assistance program.
Information on manufacturer's patient assistance programs:
- Eli Lilly and Company, Lilly Diabetes Solution Center
- Novo Nordisk, Patient Assistance Program
- Sanofi, Patient Assistance Connection
- MannKind Corporation, Co-Pay Program, Direct Purchase Program
Information on manufacturers coupon programs:
- Eli Lilly, Discounts for diabetes medicines
- Novo Nordisk, NovoLog Savings Card
- Sanofi, Diabetes Savings Program
Epinephrine Auto-Injector Affordability Program
HB23-1002 & Low-Cost Epinephrine Auto-Injectors
The Epinephrine Auto-Injector Affordability Program was created by House Bill 23-1002 (Epinephrine Auto-Injectors).
Beginning January 1, 2024, eligible individuals can receive a low-cost Epinephrine Auto-Injector for no more than a $60 copay for each 2-pack of Epinephrine Auto-Injectors. One part of this legislation applies to Colorado-regulated health coverage plans, the other part creates an Epinephrine Auto-Injector Affordability Program for those who are uninsured and those not enrolled in Colorado-regulated health coverage plans, however, that program is not available to those who are enrolled in Health First Colorado (also known as Colorado Medicaid) or Medicare.
The two parts of this law became effective on January 1, 2024.
Part 1: Cost-sharing and Coverage of Epinephrine Auto-injectors by Colorado-Regulated Health Coverage Plans
- Pursuant to this law, all Colorado-regulated health coverage plans that provide coverage for Epinephrine Auto-Injectors must cap the amount a covered person is required to pay for a two-pack of Epinephrine Auto-Injectors at no more than $60, which is often payable at the point of sale as a copayment
- This coverage requirement also applies to High Deductible Health Plans that include a Health Savings Account
- Pharmacies submit claims for this prescription fill for a two-pack of Epinephrine Auto-Injectors to the health coverage plan in order to receive reimbursement for filling the prescription from the health insurer just like they do for any other prescription
- If you have a Colorado regulated health coverage plan, including ACA-compliant health benefit plans, your insurer is required to comply with this law
- How to tell if you have a Colorado-regulated health plan? Somewhere on your insurance card you will see "CO-DOI," which means it is regulated by the Colorado Division of Insurance.
- This is not to be confused with the Epinephrine Auto-Injector Affordability Program also established by this legislation and described below
If you think your insurer is not complying with this requirement, please contact the DOI Consumer Services program at 303-894-7490 or dora_insurance@state.co.us.
Part 2: Epinephrine Auto-Injector Affordability Program
Epinephrine Auto-Injector Affordability Program Application - English
Epinephrine Auto-Injector Affordability Program Application - Spanish
Who qualifies for the Epinephrine Auto-Injector Affordability Program?
To be eligible for this program you must:
- Be a resident of Colorado
- NOT be enrolled in a Colorado-regulated health coverage plan that provides coverage for Epinephrine Auto-Injectors and that caps the amount a covered person is required to pay for a two-pack of Epinephrine Auto-Injectors at no more than $60.
- How to tell if you have a Colorado-regulated health plan? Somewhere on your insurance card you will see "CO-DOI," which means it is regulated by the Colorado Division of Insurance. If that is not printed on your card, your plan is NOT a Colorado-regulated plan.
- NOT be eligible for or enrolled in Health First Colorado (Colorado Medicaid) or Medicare
- Have a
valid Epinephrine Auto-Injector prescription - Pay more than $60 for a 2-pack of Epinephrine Auto-Injectors, regardless of the amount or type of Epinephrine Auto-Injector
- Present identification proving Colorado residency including, but not limited to, a valid Colorado identification card or driver’s license, a printed bill (utility, telephone, internet, cable, insurance, mortgage, rent, waste disposal, water or sewer, medical or other bill), a credit card or bank statement, a pay stub or earnings statement, a post-marked change of address confirmation, a printed rent receipt or residential lease, a transcript or report card from an accredited school, a vehicle title or registration, an insurance policy, a government issued letter or state or federal government issued check, or a record of medical service. In the case of a minor, the minor’s parent or guardian must provide a document with the parent or guardian’s printed name and Colorado residential address to demonstrate the minor’s proof of residency.
If you qualify for the Epinephrine Auto-Injector affordability program, you may be required to pay a $60 co-pay for each 2-pack of Epinephrine Auto-Injectors. An individual who is eligible to receive Epinephrine Auto-Injectors through the program may receive Epinephrine Auto-Injectors as prescribed for 12 months.
Epinephrine Auto-Injector Affordability Program Application - English
Epinephrine Auto-Injector Affordability Program Application - Spanish
If you have difficulty accessing this program, visit the consumer protection site of the Colorado Attorney General's Office, stopfraudcolorado.gov.
Regardless of your insurance status, you may qualify for a manufacturer's patient assistance program.
For more information on manufactures; patient assistance programs, visit foodallergy.org.
Viatris - State Epinephrine Auto-Injector Program. Viatris has provided the Division with the following information concerning their Colorado Epinephrine Auto-Injector program:
Viatris established a financial assistance portal (the “Viatris CO EAI Affordability Program Portal”) for Colorado (CO) pharmacists to access to be reimbursed for dispensing a Viatris epinephrine auto-injector prescription to an eligible patient. CO pharmacists can access Viatris’ CO EAI Affordability Program Portal here.
As a reminder, Viatris continues to offer our traditional co-pay assistance programs (the “Co-Pay Programs”) for commercially-insured, eligible patients. These programs, which are separate and distinct from the CO EAI Affordability Program, may provide savings to CO patients and often reduce the out-of-pocket expense for patients below the $60 CO EAI Affordability Program amount. CO pharmacists can access Viatris’ Co-Pay Programs here.
- Additionally, Viatris continues to offer epinephrine auto-injector products free of charge to eligible patients through our patient assistance program (the "PAP"). CO pharmacists can access Viatris' PAP program here.