$35 Insulin Medicare

Posted : admin On 1/1/2022
  1. Insulin Savings For Medicare Part D Members
  2. $35 Insulin Medicare Supplement
  3. $35 Insulin Medicare
  4. $35 Insulin Medicare Eligibility

Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool, GetInsulin.org.

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.

Insulin Savings For Medicare Part D Members

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.

Starting January 1, 2021, you may be able to get Medicare drug coverage that offers broad access to many types of insulin for no more than $35 for a 30-day supply. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in. About 30% of 2021 Medicare prescription drug plans offer insulin at a maximum co-pay of $35 or less per month throughout the initial deductible, initial coverage, and the Donut Hole. But the $35 coverage depends on the plan and the specific type of insulin.

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.

$35 Insulin Medicare Supplement


More information on the new Part D Senior Savings Model can be found here.

$35 Insulin Medicare

This content mentions Lilly, an active partner of Beyond Type 1.

$35 Insulin Medicare Eligibility

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