Medicare Caps Monthly Insulin Costs at $35

In March of this year, the Centers for Medicare and Medicaid Services (CMS) approved a $35 dollar monthly cap for Medicare Part D enrollees starting in 2021.

According to an ADA Survey, more than 1/3 of Medicare enrollees self-reported that cost limits their ability to purchase insulin.

In an attempt to make insulin more affordable for those enrolled in Medicare part D, CMS has agreed to limit the amount paid for monthly to no more than $35 per month. Insulins covered by participating plans will not be subject to the deductible or donut hole phases of Part D coverage.

Under this new option, Medicare enrollees with diabetes will pay $35 per each 30-day supply of a covered insulin prescription until they reach the catastrophic coverage phase, during which they will pay 5% co-insurance.

As beneficiaries have more consistent, predictable access to the prescription drugs they need, the model projects that health will improve and the total cost of care will decline for our nation’s senior population.

Medicare D Enrollment Cost

In exchange for these additional benefits, enhanced plans have slightly higher premiums, which are paid for by beneficiaries or through other means, such as a Medicare Advantage plan.

In 2020, average monthly premiums in Part D are $32.09 for a basic plan and $49.32 for an enhanced plan.

Affordability continues to be a barrier for people living with diabetes’ access to insulin. We hope that these changes are a step in the right direction for making insulin affordable for all.

Click ADA Website here to read more.

See CMS.gov Newsroom announcement here.


We want to hear from you!

As changes like this happen, we find that feedback from our community helps us better understand how these changes apply to real-life situations. We want to know, how have these CMS changes impacted the people you work with? Fill out our quick survey to let us know!


Insulin Cost Savings |
Resources for Diabetes Specialists

“The cost of insulin is a real problem. It can lead to insulin rationing and at its worst, people have died due to a lack of insulin,” explains Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES & ADCES 2020 Diabetes Educator of the year.

Read our article Insulin Cost Savings | Resources for Diabetes Specialists for insulin cost-saving resources.


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