CMS Lowers Medicare Insulin Copays

May 29, 2020

CMS is reducing insulin copays for seniors who are eligible for Medicare via an executive order from President Donald Trump.

The Centers for Medicare & Medicaid Services (CMS) is reducing insulin copays for seniors who are eligible for Medicare via an executive order from President Donald Trump.

Participating enhanced Medicare Part D plans in 2021 will provide a broad set of insulins at a maximum $35 copay for a month’s supply of each type of insulin, the White House said in a fact sheet on the new initiative.1

CMS estimates that beneficiaries could save $446, or 66%, a year for their insulins, the agency said in a press release.2

However, other policies to lower prices are still badly needed, according to Andrea Pivarunas, NCPA’s director of public affairs. Those policies include a pharmacy direct and indirect remuneration (DIR) fee fix, such as the one included in the Senate drug pricing bill, and efforts to reform the “warped rebate program” in Medicare Part D, Pivarunas said.

President Donald Trump announced the Medicare program as he vies for reelection. “I hope the seniors are going to remember it,” he said at a Rose Garden ceremony. He was joined by seniors, diabetes advocates, and executives from insurance and drug companies, Associated Press reported.3      

“Lowering out-of-pocket insulin costs will provide the many Medicare beneficiaries who rely on 1 or more common forms of insulin with plan options that will deliver critical relief,” the White House said.1

Related: Insulin Affordability Options Expand During COVID-19

For the first time, CMS is enabling and encouraging Part D plans to offer fixed, predictable copays for beneficiaries, “rather than leaving seniors paying 25% of the drug’s cost in the coverage gap,” CMS said.2

Part D sponsors that participate in the model will offer beneficiaries Part D prescription drug plans that provide supplemental benefits for a broad range of insulins, including both pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins.

Participating pharmaceutical manufacturers will continue to pay their current 70% discount in the coverage gap for their insulins that are included in the model, and based on the model’s waiver of current regulations, those manufacturer discount payments will be calculated before the application of supplemental benefits under the model, CMS said.2

Average basic premiums for Medicare Part D prescription drug plans are the lowest in 7 years and have fallen by 13.5% since 2017, saving beneficiaries $1.9 billion in premium costs, the White House said.1

Medicare Advantage premiums have also fallen 28% since 2017 to a 13-year low.1

References:

1. President Donald J. Trump Is Reducing the Cost Of Insulin And Improving Healthcare For Our Nation’s Seniors. Fact Sheet. White House; May 26, 2020. Accessed May 29, 2020. https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-reducing-cost-insulin-improving-healthcare-nations-seniors/

2. President Trump Announces Lower Out of Pocket Insulin Costs for Medicare’s Seniors. News Release. CMS; May 26, 2020. Acccessed May 29, 2020. https://www.cms.gov/newsroom/press-releases/president-trump-announces-lower-out-pocket-insulin-costs-medicares-seniors

3. Alonso-Zaldivar R. Most Medicare enrollees could get insulin for $35 a month. Associated Press. May 26, 2020. https://apnews.com/e19266951ca46647ce0a589339aa77c1