Starting in 2023, the Inflation Reduction Act, limits insulin out-of-pocket costs at $35 for a month for each insulin product covered by an individual’s Medicare Part D prescription drug plan or Medicare Advantage plan.

Under a Medicare Part D prescription drug plan, if insulin is a covered insulin product, the $35 cap for a month’s supply for each insulin product applies, beginning on January 1, 2023.

A covered insulin product is one that is included in a Part D sponsor’s formulary.

This includes any new insulin products that become available during the plan year. An insulin product might also be considered covered in other instances and there can be changes in covered products during the year.

In addition, under Medicare Part B, if insulin is delivered through a traditional pump that is covered under the durable medical equipment benefit, the cost-sharing amount for a person with Medicare is capped at $35 for a month’s supply of insulin beginning July 1, 2023.

The cap applies only to insulin products on a plan’s formulary, or the list of covered medications.

Unfortunately, most drug plans don’t cover the more than 70 insulin products on the market. And some plans actually charge less than $35 a month for particular products, but those lower copays are difficult to ferret out on the Medicare Plan Finder. Adding to the complexity of making a choice of plans, many people with diabetes use several prescription drugs besides insulin.

End result: Finding the lowest-cost, most effective plan that covers all of a participant’s medicines among the 20 or more plans that might be offered in someone’s zip code can be complicated, at least for 2023.

Strategies to succeed? Medicare officials and the local offices that support beneficiaries strongly recommend getting help. “People with Medicare who take insulin are encouraged to call 1-800-MEDICARE or to contact their State Health Insurance Assistance Programs (SHIP) for help comparing coverage and costs this year,” Meena Seshamani, M.D., director of CMS’s Center for Medicare, said in an emailed statement. This is just a one-year glitch, the Centers for Medicare & Medicaid Services says, so it’s best handled by those with practice navigating the Plan.

Experts suggest Medicare recipients make a list of all their prescriptions, including the dosages and how often they are refilled. Then go to Medicare.gov and create an account — it allows individuals to store their drug list securely, which can speed up the task of finding a plan.

Then they have two choices:  

• Call 1-800-MEDICARE and seek help there, or
• Go to the SHIP website to look up the agency that administers SHIP in your state.

The best bet is to call the state agency to find the county or other local office and contact a trained counselor who can analyze plan options. SHIPs objective is to provide comprehensive, unbiased information on Medicare. The counselor will make sure, for example, that any Medicare Advantage plan you consider actually covers the insulin products you need.

Click the Links Below for More Info.

---

---

Don’t worry if you can’t make our webinars live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.