Medicare Blueprint Advisors - July/August 2020

Medicare Announces Fixed Insulin Cost

At $35 for Many Part D Plans

If you’re among the 1 in 3 Medicare beneficiaries who has diabetes, your insulin bill could drop dramatically in 2021. This spring, the Centers for Medicare and Medicaid Services (CMS) announced that more than 1,750 Medicare Part D and Medicare Advantage with prescription coverage plan sponsors have vowed to provide a variety of insulins at just $35 at most per copay for beneficiaries in 2021.

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This announcement comes at a revolutionary time in the prescription drug era, as more manufacturers and

pharmaceutical companies are criticized for costly insulin prices. A study by the American Diabetes Foundation, as published in 2018, found that insulin prices tripled from 2002 to 2013. This cost continues to rise without governmental interference, and while a direct link to explain the high cost hasn’t been determined, some point to the complexity of insulin and general pricing indexes as contributing to the costs. CMS adds that the creeping costs for beneficiaries are often due to patients acquiring the added costs of higher premiums when Part D sponsors are given manufacturing costs when opting for lower-cost-sharing options. For the Medicare Part D beneficiaries who make up the 30 million patients who live with diabetes in the U.S., fulfilling this gap will no longer be a concern. In the past, a Part D beneficiary may have seen huge swings in monthly out-of-pocket costs, largely due to changing rules in coverage. The new model could provide beneficiaries with better information for budgeting and could save Medicare beneficiaries upward of $446, which CMS estimates as 66% savings. The final details of this new model are still in the works, as Medicare disseminates which plans will offer capped costs. Plan providers were given a June 1 deadline to comply. CMS estimates the model will be finalized in September 2020, allowing members the opportunity to review plans prior to enrollment, which begins on Oct. 15. Medicare Blueprint Advisors is excited about what this could mean for our clients, but we also understand how confusing this process can be. If you have questions about Medicare initiatives to decrease insulin prices and how this may affect you, then contact our team today.

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