Starting next year, for many seniors who need insulin and who are enrolled in a Medicare Part D plan or Medicare Advantage, the cost of insulin could drop to $35 a month or less, according to a new ‘insulin benefit’ announced by the White House. The American Diabetes Association (ADA) and the Centers for Medicare and Medicaid Services (CMS) were present for the announcement of the Part D Senior Savings Model, created to reduce the cost of insulin out-of-pocket copays to $35 or less for a 30-day supply.
Medicare estimates that around six in ten people are currently enrolled in prescription drug plans that will offer the new insulin benefit. Recipients aged 65+ who choose a plan offering the benefit could save an estimated $446 a year, thanks to the new lower monthly payment of $35 or less. One in three people with Medicare has diabetes, with over 3 million seniors using insulin, so this is welcome news.
The insulin benefit covers a range of insulin products, such as pens and via forms, for long- and fast-acting treatments, and will be available in all 50 states.
Tracey Brown, CEO of ADA, said in a press release: “Together, we are helping 3.3 million seniors access insulin more affordably through significant caps on out-of-pocket copays.” Brown added that, “The American Diabetes Association – the nation’s leading organization for all people living with diabetes – is committed to continuing the fight to make insulin and other drugs more affordable so that people living with diabetes can thrive, particularly in these historically challenging times."
How to get the new lower insulin monthly copay
The benefit is voluntary, so if your current plan doesn’t cover it, you will need to switch to an enhanced plan when Medicare open enrollment starts again this October. The Centers for Medicare and Medicaid Services expects the cap on copays to lead to a small increase in premiums, but offset by additional benefits including reduced cost-sharing on insulin products.
Essentially, Medicare is available for people aged 65+, as well as for younger people with disabilities and those with End Stage Renal Disease. People are eligible for premium-free Medicare Part A (hospital insurance) if they are aged 65 or older and they or their spouse has worked and paid Medicare taxes for at least ten years.
- Use the Medicare eligibility calculator to discover if you qualify for coverage.
Thanks to the new insulin benefit, fluctuating copays will be replaced by a known and more manageable monthly cost, bringing peace of mind to the many Medicare enrollees who need this life-saving medicine, used to control blood sugar levels in people with diabetes.
Insulin costs are mostly covered by Medicare Part D, while Medicare Part B plans usually cover the cost of durable medical equipment relating to diabetes management, such as the best glucose meters for monitoring blood sugar levels.
Three major insulin manufacturers are onboard with the new deal, including Eli Lilly, Sanofi and Novo Nordisk, a global insulin manufacturer that announced a free 90-day insulin supply to people who have lost health coverage during the coronavirus pandemic. It comes at a time when experts predict up to 43 million Americans could lose health insurance due to coronavirus-related job loss.
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