One in every three Medicare beneficiaries has diabetes, more than 3.3 million Medicare beneficiaries use one or more forms of insulin. The high cost of insulin is a leading concern for seniors.
For diabetics, access to insulin is a critical component of their medical care. Failing to effectively manage diabetes results in increased risk of serious complications, ranging from vision loss to kidney failure to foot ulcers, amputations and heart attacks. Unfortunately, for many seniors the cost of insulin is a barrier to appropriate medical management of diabetes.
CMS Part D Senior Saving Model is designed to address President Donald Trump's administration promise to lower the prescription drug costs and provide Medicare patients with new choices of Part D plans that offer insulin at an affordable and predictable cost where a month supply of plan-formulary insulin costs to $35 each.
Medicare Insulin Coverage Program Details- Senior Savings Model
The new Senior Savings Program allows for Medicare Part D sponsors to offer a Part D benefit design that includes predictable copays in the deductible, initial coverage, and coverage gap phases by offering supplemental benefits that apply after manufactures provide a discounted price for broad range of insulins included in the program.
The Senior Savings Model aims to reduce Medicare expenditures while enhancing the quality of care for seniors, and to provide beneficiaries with additional Medicare Part D Plan choices. There are participating stand alone Prescription Drug Plans and Medicare Advantage Prescription Drug Plans.
Beginning January 1, 2021, Medicare Part D sponsors that participate in the program will offer beneficiaries Prescription Drug Plans that provide supplemental benefits for insulin coverage in the coverage gap phase of the Medicare Part D benefit. Participating pharmaceutical manufactures will pay the 70% discount in the coverage gap for the insulins that are included in the program (click image above to see which insulin drugs are covered in the new Medicare Insulin Program), but those manufacturer discount payments would now be calculated before the application of supplemental benefits under the program.
As a result of the new program, seniors who take insulin and enroll in a plan that is participating in the Seniors Savings Model would now be saving on average $446, in annual Out-Of-Pocket costs of insulin, which is savings of about 66%. This predictable copay will provide improved access and affordability of insulin.
Participating Pharmaceutical Manufactures:
Eligible Pharmaceutical manufactures had the opportunity to volunteer to participate in the Senior Savings Model. The following Pharmaceutical Manufactures are participating in the Medicare Part D Senior Savings Program in 2021:
Eli Lilly and Company
Novo Nordisk, Inc.
Novo Nordisk Pharma, Inc.
Sanofi-Aventis U.S. LLC
Across the nation, 1,635 Prescription Drug Plans, including both Medicare Advantage Prescription Drug Plans and Stand alone Prescription Drug Plans are participating in the Senior Savings Model for 2021. This covers an estimated 13.2 million enrollees. Seniors who use insulin in all 50 States, D.C., and Puerto Rico will have a choice of a Medicare Part D Senior Savings Model participating plan in their area.
If you have any questions regarding the Senior Savings Program don't hesitate to reach out. If you would like a complimentary plan review feel free to reach out to us, or fill out your information on the contact page and we will reach out to you.