In the United States, there are 37.3 million people with diabetes. And for many, diabetes is an expensive and complex medical condition, often requiring multiple medications — including insulin — and regular doctor visits. In fact, diabetes is the most expensive chronic condition in the nation, according to the Centers for Disease Control and Prevention (CDC). The annual cost of diagnosed diabetes is an estimated $327 billion — and climbing.
Medicare Part D has helped seniors and other Medicare beneficiaries save billions of dollars on their prescription costs over the last two decades. But still, Kaiser Family Foundation notes that the total out-of-pocket spending on insulin for Part D enrollees was $1 billion in 2020.
For these consumers, a change was needed.
Current savings: The insulin demo
In March 2020, the Centers for Medicare & Medicaid Services (CMS) announced a new Part D Senior Savings Model for Medicare beneficiaries who use insulin. Plans voluntarily participated in this model to provide seniors a low, stable, predictable insulin copay. This helped members who did not already receive Extra Help and were enrolled in participating Medicare insurance plans with prescription drug coverage. Their monthly out-of-pocket costs for insulin are reduced to $35 or less per covered prescription during three phases of coverage: the deductible phase, the initial coverage phase, and while in the coverage gap.
Each of the three major insulin manufacturers and 76 Part D sponsors — covering about 2,500 insurance plans — are participating in the program.
2023 changes from the Inflation Reduction Act
In 2023, broader changes to help make insulin more affordable will take place, implemented by the Inflation Reduction Act. All Medicare beneficiaries with prescription drug coverage, regardless of income, will pay a maximum of $35 for a one-month supply of covered insulin products through all four phases of drug coverage.
While a $35 cap has been in place for most UnitedHealthcare plans with prescription drug coverage, in 2023 it will be extended to all members across all Medicare Advantage plans with prescription drug benefits and stand-alone Part D plans.
“Diabetes is already a complicated, costly, and challenging condition,” said Dr. Philip Painter, chief medical officer of UnitedHealthcare Medicare & Retirement. “These efforts illustrate how it can make things a little easier for the millions of Americans who depend on the life-saving drug, insulin.”
Keep in mind that while these changes are coming in 2023, they might not be reflected in the Annual Notice of Changes (ANOCs) during the Medicare enrollment period. You should keep an eye out for additional information in 2023 about these and other prescription drug benefits.
By helping to make insulin more affordable, the hope is that more seniors will adhere to their regimen and hit their treatment goals, giving them a better chance to get healthier. And that can mean a health care system that works better, not just for seniors, but for everyone.
Benefits, features, and/or devices vary by plan/area. Limitations and exclusions apply.
For the plans participating in the Part D Senior Savings model, you will pay a maximum of $35 for a 1-month supply of Part D selects insulin drugs during the deductible, Initial Coverage and Coverage Gap or “Donut Hole” stages of your benefit. You will pay 5% of the cost of your insulin in the Catastrophic Coverage stage. This cost-sharing only applies to members who do not qualify for a program that helps pay for your drugs (“Extra Help”).