QUESTION: Are Insulin prices coming down in the future?

Insulin has been very expensive for a number of years. I have seen many Medicare eligible individuals spend thousands of dollars each year to pay for their insulin. 2021 will be different! This year the Centers for Medicare & Medicaid Services (CMS) has developed a new Model, the “Part D Senior Savings Model”. This Model provides an opportunity for insurance companies to offer a significant savings to their enrollees on the types of insulin the insurance company includes on their formulary. The participating plans will offer co-pays of $35 or less for a 30-day supply of insulin during the deductible, initial coverage and coverage gap phases. This is a significant savings for those with Medicare who take Insulin.

In Chautauqua County, there are 11 Medicare Advantage Plans and 8 Prescription Drug Plans (PDPs) that are offering the Senior Savings Model as part of their coverage. These combined 19 plans are offering the insulin on their formulary at the cost of $35 per month or less. There are some plans that are offering as low as $11 for the insulin covered on their formulary.

For Medicare enrollees who are used to paying hundreds per month for their insulin this will be an impressive savings. As enrollees move through the phases of coverage, they will see a consistent pricing structure at the pharmacy for their insulins covered on the formulary. These individuals want to be sure to evaluate their drug coverage this year. Finding a plan using the medicare.gov website could save individuals hundreds, maybe thousands of dollars over the course of the year.

It is also worth noting that those plans participating in the Senior Savings Model are not required to cover all types of insulin at this cost structure. The enhanced coverage will be extended to those insulins they normally cover on their formulary. So Medicare enrollees need to be sure to evaluate the Part D plans available to be sure they are choosing and enrolling in a plan that covers the insulins they take.

As noted previously not all plans are offering this enhanced coverage, so the Annual Open Enrollment Period, October 15 to December 7 is especially important to those Medicare recipients on Insulin. You can compare your current plan with all the plans available to get your best possible savings. For those on Medicare who are not comfortable using a computer, you can call 1-800-MEDICARE (1-800-633-4227) to get assistance 24 hours a day, 7 days a week.

When you evaluate your options and find a plan that participates in the Senior Savings Model, you can enroll in that plan to begin January 1. You won’t see the savings at the pharmacy in 2020, the lower costs will begin January 1, 2021.

Of course the Annual Open Enrollment Period is the designated time to evaluate your current coverage in comparison with all the other plans available. This is the time to be sure that your current coverage covers all your medications and to see if any other plan is offering better savings to you if you enroll in their plan. This year that evaluation can literally save you hundreds or thousands of dollars if you take insulin.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions, concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org