Does Medicare cover Lantus in North Carolina?

What Lantus is used for

Lantus is a long-acting insulin injected once a day. Its FDA label covers improving blood sugar control in adults and children with type 1 diabetes and in adults with type 2 diabetes.

This page explains Medicare coverage only. Questions about whether Lantus is right for you belong with your prescriber.

Which part of Medicare covers Lantus

Lantus comes in vials and SoloStar pens that you inject yourself, so it's a Part D drug. Part B covers insulin only when it's used in an insulin pump covered as durable medical equipment, and the same monthly cap applies there, with no Part B deductible. Long-acting insulin like Lantus isn't used in a pump.

Is Lantus on Medicare's negotiated-price list?

Lantus is not among the drugs CMS has selected for the Medicare Drug Price Negotiation Program so far: the 10 drugs with negotiated prices since January 1, 2026, the 15 with negotiated prices starting January 1, 2027, and the 15 CMS selected on January 27, 2026, for prices that take effect in 2028.

Generics and biosimilars

FDA has licensed biosimilars to Lantus, including Semglee (insulin glargine-yfgn), the first interchangeable biosimilar insulin, approved in July 2021, and Rezvoglar (insulin glargine-aglr). An interchangeable biosimilar can be substituted at the pharmacy where state law allows. A plan may cover a biosimilar or unbranded insulin glargine instead of Lantus; the monthly cap applies to whichever covered insulin you get.

How the insulin cap works

• The cap is $35 for each one-month supply of each covered insulin, and the Part D deductible doesn't apply.
• If you fill a two- or three-month supply, the cap applies to each month in the fill.
• The cap applies to insulins on your plan's formulary. If your plan doesn't cover Lantus, ask whether it covers another insulin glargine, or request an exception.
• Extra Help can make your insulin copay even lower.

What you pay for Lantus in 2027: the out-of-pocket cap

Your cost for Lantus depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:

• 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
• The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
• Only covered drugs count. If your plan doesn't cover Lantus and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.

Spreading the cost: the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when your costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?

Extra Help with Lantus

Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have full NC Medicaid, SSI or a Medicare Savings Program, which North Carolina calls MQB (MQB-Q, MQB-B or MQB-E). Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213 (TTY 1-800-325-0778). See Extra Help in North Carolina and MQB in North Carolina.

Getting Lantus covered in North Carolina

North Carolina is its own Part D region (PDP Region 08), so each standalone Part D plan sold here is offered in all 100 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies in North Carolina. Every county also has Medicare Advantage plans open to everyone, from 11 in Carteret County to 57 in Guilford County. Each plan has its own formulary, so one plan's coverage of Lantus tells you nothing about another's. Your county's numbers are on North Carolina counties.

State Health Plan retirees: the Plan's Base Plan and Enhanced Plan are group Medicare Advantage plans that include group Part D, so your Lantus coverage comes from the Plan's formulary. Don't join a separate Part D or Medicare Advantage plan to get Lantus covered: the State Health Plan says that removes you from its group Medicare Advantage plan and moves you to the 70/30 Plan. Ask the Plan first. See the State Health Plan and Medicare.

If you have full NC Medicaid and Medicare, your Medicare drug coverage, not NC Medicaid, pays for Part D drugs like Lantus, and you get Extra Help automatically. See NC Medicaid and Medicare.

If your Medicare Advantage plan ends in 2027, your plan sends a non-renewal letter, and you have a special enrollment period through February 28, 2027. To keep Lantus covered without a gap, choose new drug coverage by December 31, 2026. See plans ending in 2027.

Substitution at North Carolina pharmacies: state law (G.S. 90-85.28) lets a pharmacist fill a brand-name prescription with an FDA-approved interchangeable biological product, such as an interchangeable insulin glargine, unless your prescriber marks the prescription "Dispense as Written." When the pharmacist dispenses a biological product, the pharmacy must let your prescriber know which product and manufacturer you got within five business days. Make sure the product you get is the one on your plan's formulary.

Hurricanes and power outages: Lantus has storage-temperature limits on its label, so a long power outage can ruin your supply; keep your plan's pharmacy number with your emergency supplies. CMS says Medicare pays to replace prescription drugs lost, destroyed or damaged in a disaster; call your plan for a replacement fill. North Carolina's emergency-refill law (G.S. 58-3-228) is written for state-regulated health plans and the State Health Plan; in a Medicare drug plan, ask the plan itself. See early refills before a hurricane.

How to check whether a plan covers Lantus

1. Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Lantus and not another.
2. Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Lantus and any rules.
3. Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
4. Check your 2027 notice. Your plan's Annual Notice of Change says whether Lantus stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
5. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your plan doesn't cover Lantus, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in North Carolina?

Sources

• National Library of Medicine — DailyMed: Lantus prescribing information (FDA label)
• Medicare.gov — Drug coverage (Part D)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
• CMS — Selected drugs for initial price applicability year 2028 (fact sheet, January 2026)
• Medicare.gov — Prescription drugs (outpatient) under Part B
• FDA — Purple Book: licensed biological products, biosimilars and interchangeables
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold, deductible and Extra Help copays)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• eCFR — 42 CFR 423.120 (formularies and transition fills)
• CMS — Medicare Advantage and Part D Landscape files, 2027 (PDP Region 08: North Carolina)
• State Health Plan — Retiree presentation (group Medicare Advantage plans, outside Medicare plans and the 70/30 Plan)
• CMS — Replacing Durable Medical Equipment and Prescription Drugs after a Disaster
• North Carolina General Statutes — G.S. 58-3-228, extra prescriptions during a state of emergency or disaster
• North Carolina General Statutes — G.S. 90-85.28, selection of equivalent drugs and interchangeable biological products by pharmacists

Frequently asked questions

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