More Part D plans will likely offer $35 monthly co-pays for insulin in 2021
More than 1,750 standalone Medicare Part D prescription drug plans and MA plans have applied to offer insulin at a maximum $35 copay for a month’s supply of the drug for the 2021 plan year, CMS announced. The $35 copay is part of the Part D Senior Savings Model, which was originally introduced in March this year as a voluntary model to test the impact of insulin access and care through alternative plans with lower out-of-pocket costs for seniors.
The rising cost of insulin over the last several years in the U.S. has become increasingly problematic for those with diabetes, causing some to dangerously ration their supplies or even travel to other neighboring countries to find the drug more affordably. More than 3.3 million Medicare beneficiaries use one or more of the most common forms of insulin and 30 million people in the U.S. have diabetes. In total, there are 959 standalone Part D prescription drug plans in 2020 and 3,970 MA prescription drug plans, meaning not all plans will carry the $35 copay for insulin in 2021.
The $35 copay will apply to a broad set of insulins from the beginning of the year through the Part D coverage gap. A total of 88 plan sponsors have applied, according to CMS, spanning all 50 states, the District of Columbia and Puerto Rico. The agency estimates beneficiaries will see average out-of-pocket savings of $446, or 66%, for their insulins.
This year, Part D plan sponsors take on more costs if they offer lower cost-sharing when patients reach the coverage gap, and members take on higher premiums to offset the costs. Under the new model, manufacturers pay their full coverage gap discount for the products even when cost-sharing is lower. Manufacturers will pay an estimated additional $250 million of discounts over the five-year model.
“This market-based solution, in which insulin manufacturers and Part D sponsors compete to provide lower costs and higher quality for patients, will allow seniors to choose a Part D plan that covers their insulin at an average 66 percent lower out-of-pocket cost throughout the year,” CMS Administrator Seema Verma said in a statement.
Medicare beneficiaries will be able to find these Part D plan in the Part D Senior Savings Model in the 2021 plan year through the Medicare Plan Finder during the open enrollment period, which runs from October 15, 2020 through December 7.
In 2020, there are roughly 46.3 million enrollees in Part D plans, and nearly 75% of total Medicare enrollees have Part D prescription drug coverage. More beneficiaries than ever are also taking part in MA programs––37.6% of all enrollees in 2020, according to CMS.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."