Making Insulin More Affordable for People with Medicare

More than 3.3 million people with Medicare use one or more of the common forms of insulin every day. Unfortunately, the cost of insulin has nearly tripled over the past 10 years, from about $100 to $300 a vial, and out-of-pocket costs for the drug for people with Medicare can significantly fluctuate from month to month, making budgeting and management of a person’s diabetes more difficult.

Starting October 15, 2020, people with Medicare will be able to enroll in a Medicare drug plan that offers insulin for no more than a $35 copay for a month’s supply. Coverage will begin on January 1, 2021. While all plans that are participating in Medicare’s new “insulin savings model” guarantee that your cost-sharing is capped at $35 for a month’s supply of insulin, some plans may offer even lower copays.

Participating plans cover different types and brands of insulin, and it’s important to check each plan’s formulary to find out your exact cost, starting in the deductible phase, and going through the initial coverage, and coverage gap phases of your Medicare drug benefit. By enrolling in a participating plan, people with Medicare may save hundreds of dollars per year on your out-of-pocket costs for insulin, and you’ll always know exactly what you’ll be paying each month.

For our existing clients, there's nothing you need to do – we will enter in your current prescriptions and will find you the lowest cost plan. If you choose to run your own drug comparisons, be sure to filter the plan options by clicking "Filter Plans" and checking the "Insulin savings" box.

For people with Medicare who have diabetes and use insulin, it’s important to have access to affordable insulin to manage blood sugar. If you’re chronically unable to afford what your health care provider has prescribed, you’re at greater risk for serious complications from uncontrolled diabetes, including vision loss, kidney failure, heart attack, stroke, and chronic nerve pain. The cost of insulin should never keep it out of the hands of people whose health depends on it, and Medicare’s insulin savings model is designed to ensure that those who need it get it. This new model just may help you better manage your health, and your pocketbook, in 2021.

Read more at American Diabetes Association or CMS