Nearly 7.5 million Americans diagnosed with diabetes use at least one form of insulin. About 45% of America’s insulin users are Medicare beneficiaries. It’s no secret that insulin can be expensive for diabetics of all ages. However, Medicare beneficiaries tend to experience fluctuating high costs throughout the year for their same insulin prescription. Because of the way Medicare Part D is designed, Medicare beneficiaries can experience four different insulin prices within one year.
The cost of popular insulins has more than doubled since 2007 for Medicare Part D enrollees. For example, the average cost for Novo Nordisk’s Novolin R has increased by 123%. In comparison, the average price for Sanofi’s Lantus Solostar has risen by nearly 300% since 2007.
By the start of 2021, Medicare beneficiaries will have access to new constant, lower insulin copays. Earlier this year, the Centers for Medicare and Medicaid Services (CMS) and the Trump administration announced the Part D Seniors Savings Model. That will save Medicare beneficiaries, on average, nearly $500 a year on insulin.
How the Part D Senior Savings Model works for medicare beneficiaries
The Part D Senior Savings Model is a groundbreaking model of prescription drug plans that will cap insulin co pays at $35 per month for Medicare beneficiaries enrolled in an enhanced model plan. The Model adjusts the cost-sharing amounts between the beneficiary, the plan carrier, and the drug manufacturer. Part D plan sponsors enrolled in the Model will agree to take on a higher cost-sharing percentage. Thus alleviating the bulk of the costs that fall on the beneficiary’s shoulders.
The Model is a voluntary program that Part D plan sponsors and drug manufacturers can choose to participate in. This is to lower the cost burden of insulin for Medicare beneficiaries throughout the country. However, as of May 2020, over 1,700 standalone Part D and Medicare Advantage plans were applied to participate in the Model, as well as the top three insulin drug manufacturers, Novo Nordisk, Sanofi, and Eli Lilly.
If enrolled in a participating plan, beneficiaries will never see a copay of more than $35 for a one-month supply of covered insulin. This means that regardless of the stage the beneficiary is in of the Part D plan, the maximum copay is $35. For example, instead of paying 25% of a $400 insulin ($100) during the coverage gap, the beneficiary will pay $35 or less.
What’s the catch?
Many beneficiaries have already voiced their worry about how these lower co pays are possible; they think it sounds too good to be true. CMS has said plan premiums may increase to help make up for the plan carrier’s added expenses. But the premiums are supposed to increase only slightly by about $1. Currently, the national average standalone Part D plan premium is $32.74.
Enrolling in an enhanced Model Part D plan
According to CMS, 54% of Medicare beneficiaries are already enrolled in an enhanced Part D plan. However, for those who aren’t already enrolled in a Model Part D plan, or those who wish to switch plans, they can do so during the Annual Election Period. The Medicare Annual Election Period is sometimes called the Open Enrollment Period. It begins on October 15th and ends on December 7th every year.
During this period, Medicare beneficiaries can enroll in, drop, or change standalone Part D and Medicare Advantage plans. Though, beneficiaries will have access to the new enhanced plans’ information as early as September.
Beneficiaries will also receive their Annual Notice of Change letters in September that tells them how their current plan is changing for the following year. Medicare beneficiaries should compare their Annual Notice of Change with the other plans available in their area during the Annual Election Period. This will help to learn which plan option is the most cost-effective for 2021.
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