Insulin copays for beneficiaries in Medicare Part D drug plans could max out at $35 a month in 2021 under a voluntary model unveiled Tuesday by the Centers for Medicare & Medicaid Services.
- Participating Part C and Part D plans will be required to cap insulin costs at $35 for a month’s supply, by applying the manufacturer rebates. This will happen year-round, even if you enter the “donut hole.
- Verma, head of the Centers for Medicare and Medicaid Services, said 1,750 insurance plans that offer drug coverage to Medicare recipients have agreed to provide insulin for a maximum copay of $35 a.
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On March 11, the Centers for Medicare & Medicaid Services (CMS) launched a new plan for some Medicare Part D participants to pay a maximum $35 copay for their monthly supply of insulin.
The program is called the Part D Senior Savings Model and applies to participating Part D enhanced plans through Medicare. These enhanced plans have slightly higher premiums (an average of $49.32 per month versus $32.09 per month) than the standard Part D plan, but offer broader prescription drug coverage.
Only insulins created by participating manufacturers will be included, but the intent is for all types of insulin to be covered, including long-acting, intermediate-acting, short-acting, and rapid-acting. As of March 11, Lilly has signed on to participate in this program once it launches on January 1, 2021. CMS is currently inviting other manufacturers to apply by March 18, 2020 to be included in the 2021 plan.
A copay cap provides consistent and predictable access to insulin, allowing insulin-dependent people with diabetes the ability to create reliable budgets for their medication needs. This is different from the current model in which Medicare Part D beneficiaries are often faced with fluctuating prescription costs month to month.
CMS reports that those enrolled in a participating plan should save “an average of $446 in annual out-of-pocket costs for insulin.” While the new model applies to a small part of the population, it reduces a significant burden for some of the most vulnerable members of the population: insulin dependent people with diabetes over the age of 65. The plan also creates a model for how copay caps may be done in future.
Insulin rationing due to unpredictable or inaccessible costs is dangerous for everyone with insulin-dependent diabetes, potentially leading to complications such as nerve damage, amputation, diabetic ketoacidosis and even death.
More information on the new Part D Senior Savings Model can be found here.
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$35 Copay For Insulin