Tresiba Manufacturer Bridge Programs: How to Get Insulin Degludec Cheaper in 2026

What Is Tresiba and Why Does Cost Matter?

Tresiba is a once-daily, ultra-long-acting basal insulin analog with a half-life exceeding 25 hours and a duration of action beyond 42 hours in most adults. The FDA approved insulin degludec on September 25, 2015 under NDA 203313 for adults and pediatric patients aged one year and older with type 1 or type 2 diabetes.

The Price Gap Between List Price and What Patients Pay

List price for a box of five Tresiba FlexTouch 100 U/mL pens (3 mL each, 1,500 units total) has exceeded $500 in U.S. Pharmacies. For patients on Medicare Part D or without commercial insurance, that number can translate into real out-of-pocket spending. The ADA's 2024 Standards of Care in Diabetes explicitly state that "cost is a major driver of insulin nonadherence," and nonadherence to basal insulin is directly associated with worsened glycemic control and higher rates of acute complications.

Clinical Rationale for Staying on Tresiba

The DEVOTE trial (N=7,637) compared cardiovascular outcomes on insulin degludec versus insulin glargine U100 in high-risk type 2 diabetes patients. DEVOTE, published in NEJM in 2017, found that degludec was noninferior to glargine for three-point MACE (hazard ratio 0.91, 95% CI 0.78 to 1.06, P<0.001 for noninferiority) while producing a 40% lower rate of severe hypoglycemia (rate ratio 0.60, 95% CI 0.48 to 0.76, P<0.001). Switching off Tresiba to a cheaper insulin without clinician guidance carries real clinical risk, which is exactly why bridge programs exist.

The My$99Insulin Savings Card (Commercially Insured Patients)

The My$99Insulin program is Novo Nordisk's broadest cost-assistance tool for people who have commercial (private) insurance. It caps total monthly out-of-pocket spending on eligible Novo Nordisk insulins, including Tresiba, at $99 per month regardless of the quantity dispensed.

Eligibility Requirements

To qualify, a patient must:

• Have commercial insurance (employer-sponsored, marketplace, or other private plan)
• Be a resident of the United States or Puerto Rico
• Not be enrolled in a federal or state government program (Medicare, Medicaid, TRICARE, CHAMPVA, or VA benefits) as their primary payer

Patients on Medicare Part D are excluded from the savings card but may qualify for separate programs described below.

How the $35 Insulin Cap Interacts With This Program

The Inflation Reduction Act of 2022 capped out-of-pocket costs for Medicare Part D insulin at $35 per month beginning January 1, 2023. CMS published the final rule on August 29, 2023. Medicare beneficiaries using Tresiba therefore pay no more than $35/month at Part D pharmacies and do not need the My$99Insulin card.

Enrollment Steps

1. Go to novonordisk-us.com or call 1-833-NOVO-411.
2. Complete the short online form with your name, date of birth, insurance ID, and prescribing clinician's NPI.
3. Download or print the savings card. Most participating retail pharmacies accept it instantly at point of sale.
4. Re-enroll or verify eligibility annually; program terms reset each January.

Processing time is typically under 10 minutes online.

Novo Nordisk Patient Assistance Program (Uninsured or Underinsured)

The Novo Nordisk PAP provides Tresiba at no cost to patients who are uninsured, underinsured, or otherwise unable to afford their medication. This is a separate program from the savings card and requires more documentation.

Income and Insurance Thresholds

Income cutoffs are tied to the federal poverty level (FPL). As of the most recent program guidance, patients whose household income is at or below 400% FPL and who lack adequate insurance coverage are the primary target population. The HHS federal poverty guidelines for 2025 set the 400% FPL threshold at approximately $60,240 for a household of one and $81,760 for a household of two (contiguous United States figures).

What the PAP Provides

Approved patients receive Tresiba shipped directly to their home or to their prescribing clinician's office, typically in 90-day supplies. No pharmacy copay applies. Most approvals are granted for 12 months and require annual re-enrollment.

Documentation Checklist

Gather these before applying:

• Most recent federal tax return or equivalent income documentation
• Proof of insurance status (or a letter of denial from an insurer)
• A completed prescription from a licensed U.S. Prescriber
• Government-issued photo ID

Applications can be submitted online at the Novo Nordisk Assistance Foundation portal, by fax, or by mail. Processing time ranges from 5 to 15 business days.

The HealthRX Access Framework classifies Tresiba assistance into three tiers based on insurance status:

| Tier | Insurance Status | Best Program | Estimated Monthly Cost | |------|-----------------|--------------|----------------------| | 1 | Commercial insurance | My$99Insulin savings card | $99 cap | | 2 | Medicare Part D | IRA $35 insulin cap | $35 cap | | 3 | Uninsured or underinsured, income at or below 400% FPL | Novo Nordisk PAP | $0 |

Insulin Pricing Transparency and the 2023 Novo Nordisk List-Price Cuts

In March 2023, Novo Nordisk announced list-price reductions of up to 65% on several insulin products, effective January 1, 2024. Novo Nordisk's public statement specified that Tresiba's list price would be reduced to $92 per 10 mL vial (100 U/mL). For many commercially insured patients whose plan calculates cost-sharing based on list price, this reduction directly lowered their copay before any savings card applied.

The ADA's position statement on insulin affordability, published in Diabetes Care in 2022, stated: "The Working Group calls for all manufacturers to transparently report net prices and to ensure that list-price reductions translate to direct savings at the pharmacy counter for patients."

Even with reduced list prices, net out-of-pocket costs vary significantly by formulary tier and deductible status. A patient in a high-deductible health plan (HDHP) who has not met their deductible could still face the full negotiated price, which is why the savings card remains relevant throughout 2026.

How Pharmacy Benefit Managers Affect What You Actually Pay

Pharmacy benefit managers (PBMs) negotiate rebates from manufacturers and assign drugs to formulary tiers. Tresiba is placed on Tier 3 (preferred brand) or Tier 4 (non-preferred brand) by most major PBMs as of 2025, according to CMS formulary data. Tier 3 copays average $47 to $95 per 30-day supply for patients who have met their deductible, while Tier 4 copays average $95 to $150.

Patients whose plan places Tresiba on Tier 4 should ask their clinician to submit a formulary exception request, particularly if a documented medical necessity exists (for example, recurrent nocturnal hypoglycemia on NPH or insulin glargine that resolved on degludec, as demonstrated in the SWITCH 2 trial).

The SWITCH 2 Trial: Medical Necessity Evidence for Formulary Exceptions

Formulary exception requests carry more weight when supported by published clinical evidence. The SWITCH 2 crossover trial (N=721) directly compared insulin degludec U100 with insulin glargine U100 in type 2 diabetes patients at risk for hypoglycemia. SWITCH 2, published in The Lancet Diabetes and Endocrinology in 2017, found a 30% lower rate of overall symptomatic hypoglycemia with degludec (rate ratio 0.70, 95% CI 0.61 to 0.80, P<0.001) and a 42% lower rate of nocturnal symptomatic hypoglycemia (rate ratio 0.58, 95% CI 0.45 to 0.74, P<0.001).

Using SWITCH 2 Data in an Exception Letter

A clinician submitting a formulary exception for a patient with recurrent hypoglycemia on glargine can cite SWITCH 2 to document that degludec has a statistically significant hypoglycemia advantage. Most insurers accept peer-reviewed trial data as supporting documentation. Ask your provider's office for a "prior authorization with medical necessity" letter rather than a standard prior authorization.

GoodRx, Mark Cuban's Cost Plus Drugs, and Other Discount Programs

For patients who do not qualify for the manufacturer savings card or PAP, third-party discount programs may still lower costs.

GoodRx Coupons for Tresiba

GoodRx negotiates cash-pay prices at participating pharmacies. As of early 2026, GoodRx cash prices for one 10 mL Tresiba vial (100 U/mL) range from approximately $85 to $160 depending on the pharmacy chain and ZIP code. Savings cards from manufacturers typically produce lower out-of-pocket costs than GoodRx for patients with commercial insurance, but GoodRx may be the best available option for uninsured patients who need Tresiba immediately while a PAP application is being processed.

GoodRx coupons cannot be combined with insurance benefits on the same claim. Patients should run both scenarios at their pharmacy and choose the lower option. Per FDA guidance on discount coupons, manufacturer coupons and third-party discount cards are not regulated as insurance products and terms can change without notice.

Cost Plus Drugs (Mark Cuban Cost Plus Drug Company)

As of 2026, insulin degludec is not listed in the Cost Plus Drugs formulary. Patients should check costplusdrugs.com periodically, as the formulary expands regularly. Cost Plus pricing, when available, is typically manufacturer cost plus a 15% markup plus $3 dispensing fee.

State Insulin Affordability Programs

Thirty-four states had enacted insulin price caps or emergency supply laws as of January 2026, according to NCSL tracking data. These state-level programs are separate from federal programs and operate independently of insurance status in many cases.

How State Programs Work

State caps typically apply at the pharmacy counter and limit cost-sharing to $25 to $100 per 30-day supply. Colorado's law, SB 21-175, was among the first and limits insulin cost-sharing to $100 per month per covered person, with no cap on quantity. Michigan's law (PA 118 of 2022) caps out-of-pocket insulin costs at $35 per month for state residents regardless of insurance status.

Patients should contact their state insurance commissioner's office or pharmacy board to determine whether their state has an active insulin affordability law that covers Tresiba specifically. Some state laws apply only to insulins on the state's essential medicines list.

HSA and FSA Eligibility for Tresiba

Tresiba is a prescription insulin and qualifies as a medical expense under IRS Publication 502. HSA and FSA funds can be used to pay for Tresiba at the pharmacy counter, through mail-order, or through a manufacturer program as long as the payment is for a prescription item.

IRS Rules That Apply

Under IRS Publication 502 (2024 edition), insulin is explicitly listed as a qualified medical expense: "You can include in medical expenses amounts you pay for insulin." This has applied without restriction since the CARES Act of 2020 removed the requirement for a prescription when purchasing over-the-counter medications, though Tresiba remains a prescription-only product and has always been HSA/FSA eligible.

Practical Steps at the Pharmacy

When paying with an HSA or FSA debit card, present the card at the pharmacy counter exactly as you would a standard debit card. If the card is declined (which can happen with some FSA cards that require itemized receipts), pay out of pocket and submit the pharmacy receipt for reimbursement through your benefits administrator. Retain all receipts for IRS documentation purposes.

HSA funds can also be used to cover the portion of costs not covered by the savings card. For example, if the My$99Insulin card caps your cost at $99, you may pay that $99 using HSA funds.

HDHP and HSA Compatibility Note

Patients enrolled in a high-deductible health plan who use an HSA should be aware that the IRS defines an HDHP as a plan with a minimum deductible of $1,650 for self-only coverage in 2025 (indexed annually). Using the manufacturer savings card before your deductible is met does not affect HSA eligibility, because the IRS rule about HDHPs restricts only certain first-dollar insurance coverage, not third-party discount programs.

What to Do If All Programs Are Denied

A small subset of patients will not qualify for the My$99Insulin card (no commercial insurance), will exceed the PAP income threshold, and will live in a state without an insulin affordability law. The following options remain:

340B Pharmacy Access

Federally Qualified Health Centers (FQHCs) and other qualifying safety-net providers participate in the 340B Drug Pricing Program, which gives them access to drugs at significantly reduced prices. Patients who receive care at an FQHC can often receive Tresiba dispensed through the 340B program at costs well below retail. Find an FQHC near you using the HRSA Health Center Finder.

Switching to a Less Expensive Basal Insulin

The ADA's 2024 Standards of Care note that NPH insulin remains a low-cost option at roughly $25 per vial at Walmart (ReliOn brand, no prescription required in most states). The glycemic and hypoglycemia trade-offs are real and should be discussed with a clinician, but for a patient rationing or skipping doses entirely, a formulaic switch under medical supervision is safer than nonadherence. The AACE 2023 Diabetes Management Algorithm recommends that clinicians consider cost as an explicit factor when selecting insulin regimens.

NeedyMeds and State Pharmaceutical Assistance Programs

NeedyMeds (needymeds.org) maintains a database of manufacturer programs, state programs, and local charitable programs. The Partnership for Prescription Assistance offers a single application portal for multiple assistance programs.

Monitoring Glycemic Control During a Payer or Program Transition

Any change in insulin formulation, concentration, or delivery device requires careful glucose monitoring. The Endocrine Society's 2022 Clinical Practice Guideline on Diabetes Technology recommends continuous glucose monitoring (CGM) for all adults with type 1 diabetes on insulin and for adults with type 2 diabetes on basal insulin who have difficulty achieving glycemic targets. If a payer transition forces a temporary insulin switch, ask your clinician to order or loan a CGM sensor for the transition period.

The ADA 2024 Standards of Care recommend a target HbA1c of <7.0% (53 mmol/mol) for most nonpregnant adults with diabetes and note that "insulin dose adjustments guided by structured glucose monitoring reduce hypoglycemia risk during regimen changes."