White House Announces Plan to Cut Insulin Prices for Medicare Beneficiaries in 2021

insulin prices

Diabetes is a chronic health condition that has been around for thousands of years. Each year there is a substantial number of senior citizens with diabetes who enroll in Medicare when they become eligible. The drug that helps regulate this disease is called insulin.  

In 2001, a vial of insulin cost up to $35, which was a $14 increase from the year 1996. In 2020, one vial of insulin can cost up to $250; keep in mind that some people need more than one vial a month.  If a senior citizen’s primary source of income is Social Security, the monthly cost of insulin could be crippling. Insulin is a critical component for diabetics, and the cost of insulin has made seniors ration or not receive insulin at all. When this happens, major complications may arise that can result in death.

On March 11, 2020, the White House announced the Part D Savings Model to cut insulin prices for Medicare beneficiaries in 2021. 

Part D Senior Savings Model

The White House made a positive announcement on how the Part D Senior Savings Model will bring relief to senior citizens regarding the cost of insulin. The Model’s design is to lower out-of-pocket spending for insulin. The Model will help improve the Part D program and will abolish any abuse or barriers in Medicare.

Since the introduction of the Senior Savings Model, over 1,700 standalone Part D and Medicare Advantage plans have applied to lower insulin costs by using the new Model. The Model is expected to be available in all 50 states, including the District of Columbia and Puerto Rico.

The Senior Savings Model will be a voluntary option that will offer senior diabetics a variety of insulins, including pen and vial dosages for the four types of diabetes. Medicare beneficiaries will now have the chance to tailor their drug plan around their chronic disease, with a capped maximum monthly spending.

Insulin copays in 2021

In the year 2021, the maximum out-of-pocket spending for a month’s supply of insulin will be capped at $35 a month. With that said, you would be spending $420 a year on insulin, which can be what some pay for a month’s worth. The cost of insulin can fluctuate and can be inconsistent; therefore, making it difficult for someone on a fixed income to budget. With that said, CMS is now encouraging Part D sponsors to offer predictable copays for beneficiaries.

The copay for insulin cannot exceed $35 a month. However, if Part D sponsors want to be competitive, you can likely receive a copay lower than $35 — this is something you will be looking for when it is time for you to enroll in the Part D Model.

When to enroll in the Part D Model

The Part D sponsors that plan to participate in the Model must submit their 2021 benefits to CMS by June 1, 2020. CMS will release premiums and insulin costs for specific Medicare plans by September 2020. Around September, you should also be receiving your Annual Notice of Change in the mail. This summary can bring you the insight you need to dictate whether you should keep your plan or change to one participating in the Part D Model.

The Annual Election Period is your time to drop, change, or switch your Part D or Medicare Advantage plan. This period takes place annually on October 15th and ends December 7th.  During this time, you can use the Medicare Plan Finder tool on Medicare’s website to research the participating plans in the Model. The Medicare Plan Finder tool will help you compare the different premiums and copays and help you make the most cost-effective decision on which plan to enroll in.

Being diagnosed with diabetes is a lot to process, much less the sticker shock that comes along with it. The Senior Savings Part D Model will hopefully bring relief to senior diabetics and will give Medicare beneficiaries the insulin options and price they long deserved.  

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