If you have insulin dependent diabetes and Medicare, there’s good news!
The Medicare Part D Senior Savings Model Insulin Savings Program began in January 2021 and will run at least through December 31, 2025.
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To…
What is the Part D Senior Savings Model Insulin Savings program?
It allows participating Medicare Advantage Prescription Drug plans and standalone Part D plans to offer insulin at a monthly copay of no more than $35 per month.
That means participating plans will have insulin priced at a stable, predictable amount that will save enrollees on their insulin costs.
What plans participate in the Insulin Savings program?
Not all plans participate. When you search for plans at Medicare.gov, check the “insulin savings” filter to see only plans that do participate.
It’s important to note that certain types of plans do not participate in this program: Private fee-for-service plans, employer/union only direct contract plans, section 1876 cost contract plans, dual-eligible special needs plans (D-SNPs), section 1833 health care prepayment plans, PACE organizations, Medicare/Medicaid plans, and religious fraternal benefit plans are not eligible to participate.
Will these plans have higher premiums?
Part D plan premiums vary from plan to plan, so like with all Part D plan comparisons, if you are comparing insulin savings Part D plans, you should compare them holistically – figure out the annual cost for each plan for all your needs.
That includes the monthly premium cost and the costs to fill all your prescription medications for the year.
What about plan restrictions, like Step Therapy, Prior Authorization, and Quantity Limits?
Plans participating in the insulin savings program still have formulary restrictions. When comparing plan costs, also compare plans based on any restrictions that affect your medications.
Is there a limit on the number of units of insulin per month to qualify for the $35.00 copay?
Generally, the maximum $35.00 copayment under the model applies to one month’s supply of insulin. This may be limited by a physician’s prescription or by plan rules on drug dosage to ensure patient safety.
Please note that if you use multiple types of insulin or have multiple prescriptions for select insulins covered under the model, each prescription would have a copayment of a maximum of $35.00 for a one month’s supply.
If you have questions about your prescription drug coverage, please feel free to call our office at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation.
We’re happy to help you make sure you are in the best Medicare plan for your unique needs.
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