Cost Is an Adherence Barrier — Here's How to Address It

You've prescribed Insulin Degludec (Tresiba) because it's the right clinical choice — ultra-long duration, flat pharmacokinetic profile, flexible dosing, and proven reduction in severe hypoglycemia. But none of that matters if your patient can't afford to fill the prescription.

Insulin affordability remains one of the most significant barriers to adherence in diabetes care. A 2023 CDC analysis found that roughly 1 in 4 insulin users reported cost-related rationing. And while the policy landscape has improved, patients still fall through the cracks.

This guide is a practical reference for providers and their care teams — covering what patients are actually paying, which programs exist, and how to build cost conversations into your workflow so patients leave your office with a plan they can afford.

What Patients Are Paying for Insulin Degludec

Understanding the cost landscape helps you anticipate patient barriers:

• Cash price (no insurance): $300–$500 per box of Tresiba FlexTouch pens
• Medicare Part D: Capped at $35/month under the Inflation Reduction Act — this is a major win, but patients need to know about it
• Commercial insurance: Varies widely. Some plans cover Tresiba as a preferred brand with modest copays; others require prior authorization or step therapy through Insulin Glargine (Lantus, Basaglar, Semglee) first
• Uninsured patients: Face the full cash price unless enrolled in assistance programs

No generic or biosimilar Insulin Degludec exists as of 2026, which limits competitive pricing pressure.

Manufacturer Savings Programs

Novo Nordisk offers several programs that can dramatically reduce out-of-pocket costs. Familiarize your care team with these so they can guide patients at the point of prescribing:

Tresiba Savings Card

• Eligible patients: Commercially insured
• Savings: May pay as little as $0–$25/month
• How to enroll: Patients can sign up at NovoCare.com or receive a card from your office
• Not eligible: Medicare, Medicaid, or other government insurance beneficiaries

Novo Nordisk Insulin Value Program

• Eligible patients: Cash-paying patients (no insurance or choosing not to use insurance)
• Savings: $35 for up to a 3-month supply of Tresiba
• How to access: Available at participating pharmacies; patient presents a program card at checkout
• Key detail: This program is separate from insurance — it's for people paying out of pocket

Novo Nordisk Patient Assistance Program (PAP)

• Eligible patients: Uninsured or underinsured with financial hardship
• Savings: Free insulin for qualifying patients
• How to apply: Through NovoCare — requires income documentation and a provider signature
• Processing time: Typically 2–4 weeks; encourage early application before the patient runs out

Pro tip: Keep PAP application forms in your office and assign a staff member to help patients complete them. The paperwork is the biggest barrier to enrollment.

Coupon and Discount Cards

Beyond manufacturer programs, third-party discount platforms can sometimes help — especially for patients in the coverage gap:

• GoodRx — Shows pricing across pharmacies; sometimes offers meaningful discounts on brand insulins
• SingleCare — Free discount card accepted at most major pharmacies
• RxSaver — Compares prices across nearby pharmacies
• InsideRx — Partners with manufacturers for additional savings

Important caveat: These discount cards do not combine with insurance copays. They're most useful for uninsured or underinsured patients, or when the cash price with a coupon is lower than the insurance copay (which happens more often than you'd think).

For a comprehensive list of patient savings options, see our patient-facing savings guide for Insulin Degludec.

The $35 Insulin Cap: What Providers Need to Know

The Inflation Reduction Act capped insulin costs at $35/month for Medicare Part D enrollees, effective January 2025. Key points for your practice:

• The cap applies to all covered insulin products, including Tresiba
• It applies at the pharmacy counter — no special enrollment required
• Many commercial insurers have voluntarily adopted similar caps
• The cap does not apply to uninsured patients (they need the Insulin Value Program or PAP)

Make sure your Medicare patients know about this — many are still overpaying because they assume nothing has changed.

Generic Alternatives and Therapeutic Substitution

When cost is prohibitive and no assistance program fits, consider therapeutic alternatives:

• Insulin Glargine biosimilars — Semglee (Insulin Glargine-yfgn) is interchangeable with Lantus and significantly cheaper. Basaglar is another lower-cost option.
• Insulin Glargine U-300 (Toujeo) — Closer pharmacokinetic profile to Degludec; ultra-long-acting with a flat profile. Also Novo Nordisk's competitor.
• Insulin Detemir (Levemir) — Long-acting alternative, though typically requires twice-daily dosing and has more variability.
• NPH Insulin — Available over the counter at Walmart for ~$25/vial (ReliOn brand). Far from ideal — significant peak and more hypoglycemia risk — but sometimes the only option for patients in crisis.

For a detailed comparison, refer patients to our alternatives guide.

When substituting, remember to adjust doses appropriately — switching from Degludec to Glargine or NPH is not a 1:1 conversion. Reduce the dose by ~20% when switching to a new basal insulin and titrate from there.

Building Cost Conversations into Your Workflow

Cost doesn't come up unless you bring it up. Here's how to make it routine:

At the Point of Prescribing

• Ask about insurance coverage before sending the prescription. "What kind of insurance do you have? Let's make sure Tresiba is covered before we send it."
• Check formulary status — If Tresiba requires prior authorization or step therapy, file the PA proactively. Don't let the patient find out at the pharmacy counter.
• Hand them a savings card — Keep Tresiba savings cards and Insulin Value Program cards in exam rooms or at checkout.

At Follow-Up Visits

• Ask directly: "Have you had any trouble affording your insulin?" or "Are you taking your insulin as prescribed, or have you been stretching doses?"
• Watch for red flags: Rising A1C in a previously well-controlled patient, missed refills, requesting smaller quantities
• Reassess annually: Insurance changes, job changes, and life events can all affect medication affordability

Empower Your Staff

• Train medical assistants and front desk staff to recognize cost concerns and direct patients to resources
• Designate a "benefits navigator" or point person for assistance program applications
• Use Medfinder for Providers to help patients locate pharmacies with Tresiba in stock — especially during supply constraints

Document It

Note cost-related barriers in the medical record. If you switch medications for affordability reasons, document why. This protects you and creates a paper trail if the patient needs to appeal an insurance denial later.

Quick Reference: Savings Programs at a Glance

• Medicare Part D → $35/month cap (automatic)
• Commercial insurance → Tresiba savings card ($0–$25/month via NovoCare)
• Cash-paying → Insulin Value Program ($35/3-month supply)
• Uninsured/low-income → Novo Nordisk PAP (free insulin via NovoCare)
• Discount cards → GoodRx, SingleCare, RxSaver (compare prices)

Final Thoughts

The clinical benefits of Insulin Degludec are clear — but they're only realized if patients can actually take it consistently. By integrating cost conversations into your workflow and knowing which programs to recommend, you can close the gap between prescribing and adherence.

For help locating Insulin Degludec in stock for your patients, visit Medfinder for Providers.