Starting in 2021 there is a new program for Medicare beneficiaries that use insulin. I have pulled this information from CMS.gov.
CMS’s Part D Senior Savings Model is designed to address President Trump’s promise to lower prescription drug costs and provide Medicare patients with new choices of Part D plans that offer insulin at an affordable and predictable cost where a month’s supply of a broad set of plan-formulary insulins costs no more than $35 each.
The idea here is that the user of insulin would pay no more than $35 per month for each insulin that he/she uses. Costs such as the deductible and the coverage gap (doughnut hole) will not apply
CMS is testing a change to the Medicare Coverage Gap Discount Program (the “discount program”) to allow Part D sponsors, through eligible enhanced alternative plans, to offer a Part D benefit design that includes predictable copays in the deductible, initial coverage, and coverage gap phases by offering supplemental benefits that apply after manufacturers provide a discounted price for a broad range of insulins included in the Model.
The Model aims to reduce Medicare expenditures while preserving or enhancing quality of care for beneficiaries, and to provide beneficiaries with additional Part D plan choices, both for beneficiaries who receive Part D coverage through standalone Prescription Drug plans (PDPs) and those who receive Part D coverage through Medicare Advantage, Prescription Drug plans (MA-PDs). These Model-participating plan benefit packages (PBPs) will provide stable, predictable copays for certain insulins that beneficiaries need throughout the different phases of the Part D benefit.
The article lists the participating pharmaceutical manufacturers.
- Eli Lilly and Company
- Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
- Sanofi-Aventis U.S. LLC
Please click here to bring up a list of the insulin brands available for the Senior Savings model.
The CMS article also recommends the use of Medicare.gov for finding plans that are participating in the program.
To pull up a 50-state, complete list of participating prescription drug plans (PDPs) and Medicare advantage (MA) plans, please click here.
The upshot of all of this is that you should have us shop your prescriptions on Medicare.gov, especially if you are using insulin, pens or vials. To do this, please use PDPHelper.com to send us a list of your prescriptions, and we’ll take it from there. End