Today, I will be discussing Part D Insulin Savings and More | Amazing Changes for 2021. Here I’ll comprehensively review the important details you need to know about Insulin, End-Stage Renal Disease (ESRD), and more. I’m excited to share the latest news for Part D and insulin. Have you heard of Part D Savings? There are also changes coming in 2021 that will make it easier for seniors with diabetes to get their medications covered. Let’s talk about what this means for you now so that we can take advantage of these savings before they change in 2021.
The Part D Senior Savings Model enables participating Part D prescription drug plans to provide a wide range of insulin at a maximum of $35 per month’s supply, throughout the deductible, initial coverage, and gap phases of their Part D drug plan.
If you are a senior citizen who shops for your own medication, you may have heard of the Part D Senior Savings Model. But what is it, exactly? And how can it save you money on prescription drugs? Here’s everything you need to know about this program and how to take advantage of its discounts.
When Can a Patient Enroll in Medicare Part D?
Insulin-dependent diabetic seniors will be able to sign up for new Medicare Part D Prescription Drug Plans. Or Medicare Advantage (Part C) plans including Prescription coverage from a program called The Senior Savings Model. These plans Part D Insulin Savings cap insulin co-payments at $35 for a month’s supply. This Annual Enrollment Period will begin from October 15 and last through December 7th for a January 1st effective date. According to a press release from The American Diabetes Association. CEO Tracey Brown said at a White House event to announce the Part D Senior Savings Model that the American diabetes association: “Is committed to continuing the fight to make insulin and other drugs more affordable so that people living with diabetes can thrive.“
The press release declares that people with diabetes in the US account for 33% of every dollar spent on drugs. Also, diabetics spend about 2 and a half times more on healthcare expenses than other Americans. This new model is the first federal measure designed to drive down insulin costs. As always look below the blog for links that I reference.
What Percent of Americans Over 65 are Diabetic?
According to diabetes.org, 26.8% of Americans age 65 and older have diabetes. That’s 14.3 million seniors (diagnosed and undiagnosed). The White House claims that more than 3 million people on Medicare use insulin to help with their diabetes control. For diabetics requiring insulin, it’s a life-saving component to manage their chronic condition. By lowering the cost, or access to insulin can be an overall cost-saving measure for Medicare.
When more insulin-dependent diabetics are able to access insulin, this staves off more serious complications that come from diabetes. Including kidney failure, heart disease, stroke, vision loss, and much more. According to an article on cnn.com, Insulin costs between $2.28 and $3.42 for a drug manufacturing company to produce. An article from WebMD states, “The new price caps are not the U.S. first: A number of private insurers, pharmaceutical companies, and nine states have already introduced various policies or legislation to limit the cost of insulin. States with laws that already cap insulin costs to between $25 and $100 a month include:
- New Mexico
- West Virginia
- New York
Part D Insulin Savings Cap Costs and Premiums: It’s not as Difficult as You Think
The Centers for Medicare and Medicaid Services head, Seema Verma acknowledges, plans that will offer the insulin cap will have a higher premium. Verma sites the extra premium will be around $17 per month. However, in exchange for this monthly price increase, the maximum fixed copay for a month’s supply of insulin will be capped at $35. Verma also states seniors will save around 66% on their insulin costs. According to Verma, this insulin cap costing can also be a precursor. If successful, in an attempt to lower the cost of other expensive drugs. Verma states, “we’re starting with insulin, but depending on the progress of this, we will consider offering this flexibility to manufacturers and plans with other drugs, depending on the results,”
She goes on, “We think this creates a foundation and a platform to fix some of the problems in the Part D plan. It’s time for that program to be updated.”
Holly Campbell, a spokesperson for PhRMA, a pharmaceutical trade industry association, notes “Insulin isn’t the only diabetes medication with a steep price tag. Newer medications for type 2 diabetes, such as GLP-1 and SGLT-2, may also be priced out of reach for those on certain insurance plans.” I don’t know what glp1 and sglt 2 are but if you’re curious go ahead and google em up. If you want to join the conversation, leave a comment below on what you found.
How Many Insurers Have Agreed to Participate in the Senior Savings Model?
88 different insurers have agreed to participate in the Senior Savings Model for Medicare drug benefits. Around 1,750 different Part D, prescription plans and Medicare Advantage plans with Medicare Part D drug coverage will participate in the Senior Savings Model. The Part D Senior Savings Model was announced on March 11, 2020. Participation in the Part D Senior Savings Model is entirely voluntary by Part D insurers. By participating in this model, Part D plans will be able to provide supplemental benefits for a broad range of insulins. Including
- Pen and vial dosages for rapid-acting
- Long-acting insulins
If a Part D insurer wishes to participate in the Senior Savings Model, participating pharmaceutical manufacturers will pay their discount for insulin during the coverage gap. The pharmaceutical manufacturers’ discount is 70%. Under the current Part D plan model, Part D plans can offer lower cost-sharing than is required by Medicare in the coverage gap if they choose. However, when a Medicare Part D plan does this, the Part D sponsor (private insurance company) takes on costs that the pharmaceutical manufacturer normally would pay.
Subsequently, this results in higher premium costs to Medicare Part D plans for the Medicare beneficiary. The new insulin model will allow manufacturers to continue paying their full coverage gap discount for the insulin. Even when the Medicare Part D plan already offers lower cost-sharing. Next, this will require a Part D plan that decides to participate in the new insulin model. This is to lower cost-sharing or co-pays to a maximum of $35 for a month’s supply for the broad set of insulins.
Points to Remember about The Senior Savings Model Plan
What’s important to remember with this new plan, is if a Medicare beneficiary has a prescription plan that participates in the insulin cost-saving measures, the $35 cap will apply to all phases of Medicare Part D coverage. This means the $35 cap will also apply when a Part D beneficiary is in the coverage gap. (Also known as the donut hole) and the catastrophic coverage phase as well. This fluidity of cost was one of the Centers for Medicare and Medicaid Services (CMS) goals.
With current coverage rules for Part D, costs can fluctuate greatly month-to-month during the four coverage phases which are the Deductible, Initial Coverage, Coverage Gap, and Catastrophic. To learn more about Medicare Part D prescription coverage and how these phases work, you can go to my article link below and also watch my video.
What Experts are Saying about 12 Insulin Fills Costs
The New England Journal of Medicine reports in 2019, that the typical Part D plan that is covering a Medicare Beneficiary using long-acting insulin and also has no other drug expenditures will spend around $1,140 for 12 insulin fills during 2019. This means in 2021 if this same example Medicare beneficiary is used. These 12 insulin fills will result in a total cost of $420 which’s 12 fills x $35. This example has a savings of $720 for the year. These plans will begin in January of 2021. These plans are available in all 50 States, the District of Columbia, and Puerto Rico.
Furthermore, if you’re an insulin-dependent diabetic, this year’s Annual Enrollment Period will be especially important to you. This will be your chance to shop and compare costs and benefits in your area of all the companies offering stand-alone Medicare Part D prescription coverage. Or Medicare Advantage Part C plans, that include Part D drug coverage to see which plans will fit your specific needs. You must submit the calendar year 2021 plan benefits to (CMS) by June 1, 2020. For those Part D plan sponsors that applied. The final information on the Senior Savings Model is expected in September of 2020 and will include premiums and costs.
Conclusion — Part D Insulin Savings and More | Amazing Changes for 2021
Thank you for reading the article today! Moreover, I’m glad that it was informative and helpful, especially to those who are struggling with diabetes. If this post has helped you in any way or if there’s anything else we can do for you please don’t hesitate to call us at 800-910-3382 anytime day or night. We are here 24 hours a day, 7 days a week. Did you enjoy reading the article? Let me know by posting a comment below!
About The Author — Christopher Duncan
I’m Chris Duncan, owner of Trusted Benefits Direct. As your Medicare advisor, I want you to know that my business offers superior solutions for everyone. I do not work for insurance companies, which allows me to serve you at a high level without any hidden agendas or conflicts of interest. All resources are provided at no cost because people must find peace of mind when looking ahead years down the line.
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