Medicare does cover Tresiba for most beneficiaries, and when it is covered, you pay no more than $35 for a 30-day supply with no deductible. Coverage runs through Medicare Part D, the prescription drug benefit, because Tresiba (insulin degludec) is injected with a prefilled pen rather than delivered through a durable pump. Novo Nordisk reports that the majority of Part D plans include Tresiba on their formularies, though several large insurers removed it for 2026.1Novo Nordisk. Tresiba Cost and Coverage
Which Part of Medicare Pays
How you take an insulin decides which part of Medicare covers it. Part D covers injectable insulin used with pens or needles, insulin used with certain non-durable pumps, and inhaled insulin. Part B only covers insulin when it is delivered through a durable medical equipment insulin pump.2Medicare.gov. Insulin Coverage3CMS.gov. Medicare Covers Insulin
Tresiba is a once-daily basal insulin given by subcutaneous injection, usually from a FlexTouch pen. That puts it under Part D for nearly everyone who uses it. If you have Original Medicare, you need a standalone Part D plan to get Tresiba covered; if you have a Medicare Advantage plan, drug coverage is typically built in.
What You Actually Pay
The Inflation Reduction Act of 2022 capped out-of-pocket costs for insulin at $35 per one-month supply of each covered insulin product. The cap took effect for Part D on January 1, 2023, and for Part B on July 1, 2023. Every Part D plan has to honor it.4CMS.gov. Anniversary of the Inflation Reduction Act5KFF. The Facts About the $35 Insulin Copay Cap in Medicare
For Tresiba, that means a 30-day supply costs no more than $35, a 90-day supply no more than $105, and the Part D deductible does not apply.2Medicare.gov. Insulin Coverage3CMS.gov. Medicare Covers Insulin Tresiba is usually placed on Tier 3 (Preferred Brand) when a plan does list it, but the $35 cap overrides the usual tier-based cost-sharing through all phases of Part D coverage.6Q1Medicare. Tresiba FlexTouch Part D Drug Finder Novo Nordisk reports that more than 90% of Medicare Part D patients filling Tresiba prescriptions pay under $50, with the average around $20.1Novo Nordisk. Tresiba Cost and Coverage
Beneficiaries who get the Low-Income Subsidy (Extra Help) are also subject to the $35 cap, but typically pay less. In 2026, Extra Help copays are no more than $12.65 for brand-name drugs and $5.10 for generics, and you pay whichever is lower between the Extra Help copay and the plan’s copay.7Medicare Interactive. Drug Costs Under Extra Help Novo Nordisk estimates Extra Help patients likely pay $11.20 or less per month for Tresiba.1Novo Nordisk. Tresiba Cost and Coverage
Individual plans can still require prior authorization, step therapy, or quantity limits for Tresiba. These are plan-level restrictions, so they vary. The Medicare Plan Finder on Medicare.gov shows under “Other drug information” whether any of these apply to a specific plan.8AARP. Medicare Part D Restrictions
Plans That Dropped Tresiba for 2026
Several major insurers removed Tresiba from their 2026 formularies effective January 1:
- UnitedHealthcare classified Tresiba as non-formulary across its individual and select employer-group Medicare Advantage plans and its standalone Part D plans. Listed alternatives are Lantus, Lantus SoloStar, Toujeo SoloStar, and Toujeo Max SoloStar.9UnitedHealthcare. MA Part D Plan Changes
- Wellcare removed insulin degludec from its Medicare Part D formulary and points members to insulin glargine-yfgn and Toujeo.10Wellcare. Wellcare 2026 Formulary Changes
- HealthSpring Medicare Advantage prescription drug plans removed Tresiba, listing Lantus and Toujeo as alternatives.11HealthSpring. Drug List Formulary
Other large plans kept it. Humana’s Premier Prescription Drug Plan lists Tresiba on Tier 3 for 2026, and Aetna’s 2026 Standard Plan drug guide includes Tresiba as a covered antidiabetic insulin.12Humana. 2026 Commonly Prescribed Drug List – Humana Premier PDP13Aetna. 2026 Drug Guide Aetna Standard Plan Because formularies change every year and vary by region, confirm coverage against your own plan’s drug list or run your prescription through the Medicare Plan Finder.
What To Do If Your Plan Dropped Tresiba
You have three practical paths.
Request a formulary exception. You, your doctor, or a representative can ask the plan to cover Tresiba despite the formulary. Your prescriber submits a supporting statement, verbally or in writing, explaining that Tresiba is medically necessary and that the plan’s alternatives would be less effective or cause adverse effects. The plan must respond within 72 hours for a standard request or 24 hours for an expedited one. If granted, the exception lasts through the end of the plan year as long as you stay in the plan and your doctor keeps the prescription active. If denied, you can appeal.14CMS.gov. Part D Exceptions15Triage Cancer. Medicare Drug Exception Request
Switch to a covered basal insulin. The most common replacements are insulin glargine products: Lantus, Toujeo, and biosimilars such as insulin glargine-yfgn (Semglee). Clinical studies have found them similarly effective to Tresiba, though Tresiba has been associated with a somewhat lower rate of hypoglycemia.16Tresiba.com. Tresiba FAQs The American Diabetes Association recommends a unit-for-unit conversion between basal insulins, with a possible 10–20% dose reduction for patients at high risk of low blood sugar.11HealthSpring. Drug List Formulary Any switch should go through your doctor.
Switch plans during open enrollment. Medicare’s annual enrollment period runs October 15 through December 7. The Plan Finder lets you enter your medications and compare estimated annual costs across every plan in your area.17eHealthInsurance. Comparing Medicare Part D Coverage
If You Still Can’t Afford It
Effective January 1, 2026, Novo Nordisk cut Tresiba’s U.S. list price by 72%. The monthly list price for Tresiba U-100 FlexTouch dropped from $508 to $141.18Fierce Pharma. Novo Nordisk Slashes Prices on More Insulin Products For Medicare beneficiaries with Part D coverage this changes little, since the $35 cap already applies, but it matters for cash payers and anyone caught without coverage.
Novo Nordisk also runs a Patient Assistance Program that provides free Tresiba to qualifying Medicare patients. For 2026, household income must be at or below 400% of the federal poverty level. Applicants with income below 150% of the federal poverty level must submit proof that they were denied Medicare Part D Extra Help. People enrolled in Medicaid or Extra Help are generally not eligible unless they provide a denial letter. Applications go through diabetespap.novocare.com, and approved medication ships to the patient’s home at no cost. Novo Nordisk removed some drugs from the PAP for 2026, including Ozempic for Medicare Part D patients, but insulins including Tresiba remain available.19NovoCare. Patient Assistance Program20340B Price Guide. Changes to Novo Nordisk Patient Assistance Program 2026