The White House has announced updates to Medicare coverage dealing with Part D plans and insulin drug prices for 2021. The Centers for Medicare and Medicaid Services (CMS) unveiled a Part D Senior Savings Model that would cap the cost of many insulins. Beneficiaries can expect a maximum copay of $35 for a one-month supply.
More than 1,750 stand-alone Medicare Part D prescription plans have already applied to offer lower insulin costs starting next year. Nearly a third of people on Medicare are believed to have diabetes. Out of pocket costs for insulins have been steadily rising in recent years.
These costs have created many budget issues for Part D beneficiaries under the current Part D benefit design. With this announcement, millions of Medicare members that need insulin can expect relief from the burden of these costs.
Currently, after reaching the coverage gap, users have to pay 25% of the overall cost of insulin. Many Part D beneficiaries found themselves rationing medications or even going without. In 2021, these beneficiaries can expect an average savings of $446 for their health care insulins, according to CMS.gov. That’s a savings of 66%.
These savings are funded in part by insulin manufacturers. They will pay an estimated $250 million of discounts over the five years of the model. Private insurance companies and other Part D sponsors will be able to offer these lower prices for plans starting on January 1, 2021.
The Medicare Annual Enrollment Period runs from October 15, 2020, through December 7, 2020. During this time, beneficiaries will be able to make changes to their Part D Prescription Drug plans. These 2021 plan year changes will start on January 1.
It is important to note that not all plans will participate in this program. Making sure you know which providers participate in the model changes will literally save you money! Understanding initial coverages, cost-sharing, and other supplemental benefits of Medicare will ensure you have the best coverage.
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If you have more questions about this recent announcement, please reach out to VibrantUSA. We have been working with clients since 2003, making sure they understand year over year changes.
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