Calendar Year 2027 Insulin Prescription Caps

4315 South 2700 West, Suite 2300, Taylorsville, Utah 84129 ● Office (801) 957-9200 ● Facsimile (385) 465-6047 ● insurance.utah.gov State of Utah SPENCER J. COX Governor DEIDRE M. HENDERSON Lieutenant Governor Insurance Department JONATHAN T. PIKE Insurance Commissioner BULLETIN 2026-1 To: Insurers Offering a Health Benefit Plan From: Jonathan T. Pike, Insurance Commissioner Date: February 26, 2026 Subject: Calendar Year 2027 Insulin Prescription Caps The Utah Insurance Department issues this Bulletin under Utah Code § 31A-22-626, Coverage of diabetes, and Utah Admin. Code R590-200, Diabetes Treatment and Management. This Bulletin notifies an insurer offering a health benefit plan of the annual inflation adjustment cap on the average wholesale price for insulin. A policy issued or renewed during the 2027 calendar year with a 30-day prescription supply must offer at least one insulin in each therapy category. A 30-day prescription supply cap is set at $5.00 for § 31A-22-626(4)(a) and $30.00 for § 31A-22-626(6)(b). The insulin cap is calculated using data provided by the Public Employees Health Plan (PEHP). PEHP calculated the Average Wholesale Price per Milliliter (AWP/mL) of insulin for calendar years 2019 through 2025. PEHP included all insulin modes and therapy categories in the calculation. For 2027 plans, the $30 and $100 caps in place for 2021 are adjusted as follows: Calendar Year Avg AWP/mL % change in AWP/mL 2019 $40.18 n/a 2020 $37.86 -5.8% 2021 $36.30 -4.1% 2022 $36.82 1.4% 2023 $37.24 1.1% 2024 $14.45 -61.2% 2025 $13.30 -8.0% 2027 cap = (2025 Avg AWP/mL / 2019 Avg AWP/mL) * Base Cap or 2027 low cap = (13.30 / 40.18) * $30 = $9.93, rounded down to the nearest multiple of five dollars = $5 2027 high cap = (13.30 / 40.18) * $100 = $33.10, rounded down to the nearest multiple of five dollars = $30 The price of insulin through the Utah Insulin Savings Program, under § 31A-22-626(6)(a), is available at https://www.utahinsulin.net/. An insurer with questions about this Bulletin is advised to contact the Health and Life Division at health.uid@utah.gov. DATED this 26th day of February 2026. _________________________________ Jonathan T. Pike Insurance Commissioner