Why Insulin Coverage Can Seem Backward (and What HeyMOE Does About It)

HeyMOE Tip

If your insulin appears as “Not Covered,” that doesn’t mean you did something wrong — it means your plan likely covers only the brand-name version instead of the generic.
Use the Insulin Brand & Generic Comparison Chart

Let’s Be Honest: Insulin Coverage Makes No Sense

If you’ve ever looked at your Medicare Part D results and thought, “Wait — the generic isn’t covered, but the brand-name is?!”

You’re not wrong — and you’re definitely not alone.

Insulins are one of the strangest exceptions in Medicare Part D. In many cases, the brand-name insulin is covered while its generic equivalent is not.  Then, there are plans that do not cover certain brand names but will cover others. It defies logic — but it’s how insurers’ formularies are actually built.

Why This Happens

You’d think generics would always be cheaper and more widely covered. But with insulins, it’s often the opposite.

Here’s why:

• Generics and brands don’t line up cleanly.
  A single generic insulin may be considered equivalent to several brand-name versions. Because of that overlap, Part D plans often don’t categorize them neatly — or don’t bother listing the generic at all.

• Plans cover what gives them the best deal.
  Drug coverage isn’t always about what’s cheaper at the pharmacy — it’s about the rebates and contracts negotiated behind the scenes. If an insurer gets a better price deal on Humalog than Insulin Lispro, they’ll cover Humalog and exclude the generic.

• Medicare doesn’t force consistency.
  CMS doesn’t require plans to treat brand and generic insulins the same. So one plan might cover Humalog, another might cover Novolog, and a third might exclude both.

So if you’re seeing Insulin Lispro listed as Not Covered, but Humalog is fully covered — yes, that’s exactly how the system currently works.

What HeyMOE Does Automatically

When you enter your medications, HeyMOE runs deep plan comparisons to find the lowest total cost across all your prescriptions — including your insulins.

However, we don’t automatically cross-match insulin brands and generics because the relationships aren’t one-to-one. One “generic” insulin can map to multiple brand versions, and automatically swapping them could produce incorrect or confusing results.

Instead, HeyMOE flags the uncovered insulin so you can discuss brand-name alternatives directly with your doctor or pharmacist.

What You Can Do Next

If your insulin shows up as “Not Covered” in your HeyMOE results, here’s what to do:

1. Check the brand-name equivalent

   Ask your pharmacist or prescriber whether there’s a brand version (like Humalog or Novolog) that your plan covers.  Use this link to help you determine alternatives.

2. Check Discount Programs

   Sites like GoodRx and Singlecare can help you find lower retail prices when medications are not covered.

3. Confirm before filling your prescription

   Because formularies vary, always verify which version is covered before filling. Your pharmacy can tell you instantly whether the brand or generic will go through insurance.

4. Check again next year

   Formulary coverage for insulins changes frequently. HeyMOE automatically re-runs your medication list each Medicare Open Enrollment (October 15–December 7) to catch new coverage patterns.