Excellent news coming in 2021 for our Medicare diabetic population regarding insulin costs. 

CMS (Centers for Medicare and Medicaid Services) announced on March 11, 2020, that the Part D Senior Savings Model plan will be in effect for 2021 plans.  Medicare beneficiaries can enroll during open enrollment from 10/15/2020 – to 12/07/2020.  It is a voluntary model which will give beneficiaries a maximum copay of $35 a month for their insulin and this will continue through the coverage gap.

Over 1750 standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model plan.  It is estimated that consumers will save an average of 66% or $446 for their insulin.  This is funded in part by manufacturers who will pay an estimated additional $250 million of discounts over the five years of the model.

Partnerships have been forged with pharmaceutical manufacturers to deliver lower insulin costs and higher quality to our seniors.  During the coverage gap manufacturers will continue to pay the current 70% discount for the insulins included in this model, and based on the model’s waiver of current regulations those manufacturer discount payments will be calculated before the application of supplemental benefits which will reduce the out-of-pocket cost of insulin for Medicare beneficiaries.

One in every three Medicare beneficiaries has diabetes.  Access to affordable insulin is a crucial component of managing their medical needs.  Currently, the beneficiary’s out-of-pocket costs vary from one month to the next, due to different rules applying to each phase of the Part D benefits, such as deductibles, coverage gap, etc.  This leads to beneficiaries not being able to afford their medicines, which leads to rationing and results in worse health outcomes over time.  This new model aims to address these issues by offering predictable and stable costs for insulin.

The CEO of the American Diabetes Association, Tracey D. Brown, said in a statement, “Together we are helping 3.3 million seniors access insulin more affordably through significant caps on out-of-pocket co-pays.” She said that this will help people living with diabetes, 7 million of whom are insulin-dependent, and it comes from years of pressing federal and state lawmakers to help lower the cost of insulin and other drugs for seniors with diabetes.

Part D sponsors had to submit their 2021 calendar year plans to CMS by June 1, 2020.  The 2021 premiums and costs for specific Medicare Health and drug plans have an anticipated release of September 2020.

CMS has also taken actions to address the needs of diabetics with actions such as coverage for continuous glucose monitors (CGM) for patients who synchronize their insulin devices with their smartphones.

The president and CEO of AHIP, Matt Eyles, praised the initiative. He said, “Innovative voluntary programs like this Part D Senior Savings Model are an excellent example of public-private partnerships where everyone wins, but especially patients.”

In conclusion, this is fantastic news for the Medicare diabetic population!!

If you have any questions, feel free to reach out, we would be happy to help.

*Medicare Insurance Specialty Group is not approved by or affiliated with a government agency.

*Image by Steve Buissinne from Pixabay 

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