New CMS Model will Reduce Out-of-Pocket Costs for Insulin to $35 for Medicare Part D Beneficiaries
The Centers for Medicare and Medicaid Services (CMS) has announced it will allow Medicare Part D prescription drug plans to cover insulins with a $35 monthly co-payment throughout the plan year. Generally, Medicare Part D plan coverage has different phases, including a deductible, the donut hole and catastrophic coverage. Under this new option, Medicare enrollees with diabetes will pay $35 per each 30-day supply of a covered insulin prescription until they reach the catastrophic coverage phase, during which they will pay 5% co-insurance. Insulins covered by participating plans will not be subject to the deductible or donut hole phases of Part D coverage. These enhanced Medicare Part D plans will be available in 2021.
LaShawn McIver, MD, MPH, Senior Vice President of Government Affairs & Advocacy for the American Diabetes Association (ADA), issued the following statement:
"Medicare beneficiaries are being impacted by the skyrocketing cost of insulin—more than a third of self-reported Medicare beneficiaries said cost impacted their purchase of insulin in an ADA survey. We are pleased the Centers for Medicare and Medicaid has taken this important step to bring down the cost of insulin for Medicare beneficiaries.”
“As part of our efforts to make insulin affordable for all who need it, we have been working at the state and federal levels to advance legislation and regulations that limit how much people with diabetes pay for their insulin each month. This Medicare Part D plan option will help ensure the 3.3 million Medicare Part D plan enrollees who use insulin have more manageable and consistent monthly costs. While the fight for affordable insulin is far from over, this model is an important step forward."
The ADA continues to be the driving force in federal and state efforts to ensure that insulin is affordable and accessible for all people who need it. Take action today at diabetes.org/advocacy/platform.
If you are struggling to pay for insulin or know someone who is, the ADA has resources to help—visit InsulinHelp.org.
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About the American Diabetes Association
Every day more than 4,000 people are newly diagnosed with diabetes in America. More than 122 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For nearly 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).