Blog

INSULIN PRICE CUT FOR MEDICARE BENEFICIARIES

Danielle Kunkle Roberts 15 Sep 2020
INSULIN PRICE CUT FOR MEDICARE BENEFICIARIES

Disclaimer: Please note that Mya Care does not provide medical advice, diagnosis or treatment. The information provided is not intended to replace the care or advice of a qualified health care professional. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen.

Insulin is critical among many Americans, as diabetes is the seventh leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC). Among the diabetics across the nation, 3.3 million are Medicare beneficiaries, according to the White House.

The Americans with Disabilities Act (ADA) states that seniors with diabetes pay twice as much for healthcare than non-diabetic seniors. Having access to insulin is crucial, but insulin comes with a hefty price that many of these senior citizens cannot afford. For example, in 2020, one vial of insulin can cost up to $250 -- and many seniors need several vials a month, which is why there will be an insulin price cut for Medicare beneficiaries in 2021.

Part D Senior Savings Model

The cost of insulin can vary from one month to the next, depending on the phase of the Part D plan the beneficiary is in. Therefore, leaving insulin with un-predictable costs. Luckily, the Part D Senior Savings Model was created to give these seniors predictable out-of-pocket costs for their much-needed insulin.

The Part D and Medicare Advantage plans who will participate in this new model will offer a $35 maximum copay for a month’s supply of insulin. The Centers for Medicare and Medicaid Services (CMS) encourages all carriers to offer these fixed, predictable copayments to their beneficiaries. So far, 1,750 carriers will participate in the model.

Part D carrier requirements

The CMS anticipates that the Part D Senior Savings Model will be available in all 50 states, including Puerto Rico and the District of Columbia. For a carrier to join the model, they must meet certain requirements. For example, the carriers must offer all four types of insulin on the drug formulary: long-acting, short-acting, intermediate-acting, and rapid-acting.

The participating carriers must also cover both vial and pen dosage for each of the four insulins on the drug formulary. When a carrier joins the model, they must agree to a maximum $35 copay for all insulins. A carrier cannot increase the price of insulin based on the brand, pharmacy, type, or Part D plan stage.

However, a carrier can lower the copayment amount if they wish to be competitive. Therefore, a beneficiary could possibly find a Part D or Medicare Advantage carrier who will offer a copayment for insulin lower than $35 for a 30-day supply. 

Drug manufacturers and carriers cannot exclude any insulin product from the model. With all this said, seniors who choose to enroll in a participating Part D or Medicare Advantage plan will lower their out-of-pocket costs for insulin by 66 percent.

How to enroll

The CMS expects to release the new premiums and costs for Part D plans for the upcoming new year in September 2020 and include more information over the Part D Senior Savings Model. Around the same time, Medicare beneficiaries will receive their Annual Notice of Change for their Medicare Advantage and Part D plans. This notice of change will state the changes that will be made to the beneficiary’s premiums, copayments, and more.

Therefore, a beneficiary will find out if their plan will be participating in the model, and if not, they can enroll in a model plan during the Annual Election Period (AEP). The AEP will begin on October 15th and end on December 7th. During this period, a beneficiary can enroll, drop, or change their Medicare Advantage plan or Part D plan.

CMS has made updates to their Medicare Plan Finder tool on their website, which will include a filter that will demonstrate which plans are participating in the Part D Senior Savings Model. During the AEP, seniors will want to utilize the Medicare Plan Finder Tool to ensure they will enroll in a plan offering the new capped out insulin prices.

The Part D Senior Savings Model will have an effect on millions of senior citizens across the nation. This model will leave seniors with predictable out-of-pocket costs and will give them the ability to save thousands of dollars in their future. Visit Medicare.gov or contact your insurance agent for more information on the Part D Senior Savings Model.  

To search for the best healthcare providers worldwide, please use the Mya Care search engine.

About the Author:
Danielle Kunkle Roberts is a founding partner at Boomer Benefits and a Medicare Supplement Accredited Advisor. She and her team help thousands of baby boomers learn the ropes regarding Medicare every year.
Inquire Now