1,750 Medicare Advantage, Part D Plans Sign Up for Insulin Project
More than 1,750 Medicare Advantage and Medicare Part D plans will participate in a new Part D Senior Savings Model that will allow the plans to offer much-reduced insulin costs for enrollees starting in the 2021 plan year, the Centers for Medicaid and Medicare Services has said.
The new Part D Senior Savings Model, announced in March by CMS, will require participating plans to limit cost-sharing for a 30-day supply of insulin to no more than $35. The agency estimates beneficiaries in participating plans could save an average of $446 (66%) in out-of-pocket costs for insulin, funded in part by manufacturer discounts.
This is good news as one in every three Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. With so many plans having signed, most seniors will be able to find a plan that offers this program.
Under the savings model, the plans can offer a number of insulin brands to choose from with the maximum copay set at $35 for a one-month supply. The model established a fixed monthly copay for the coverage gap phase of Medicare coverage, as well.
You'll enter the coverage gap portion (also known as the "donut hole") when the total of what you and your drug plan have paid for your medications in 2020 reaches $4,020. Once you are in the donut hole, you pay 25% of the cost of your medications. But this new model ensures that you will pay a maximum of $35 a month for insulin, even while you are in the donut hole.
The next step
Three pharmaceutical manufacturers had agreed to participate in the model as of March 23 and are offering more than 60 different insulin options among them.
As you prepare for open enrollment for the 2020 plan year, remember to look out for the Part D Senior Savings Model to see if it has been added to your existing plan. If it isn't and you want to take advantage of this model, you can work with us to shop around for a new Medicare Advantage or Part D carrier that does include it.
Interestingly, some health insurers have already been pushing down their out-of-pocket requirements for insulin, with some offering insulin at a $0 copay.
CMS will release plan model information in September.