Perspectives on Diabetes Care

CMS Finalizes Part D Senior Savings Model to Help Lower Insulin Costs for Medicare Beneficiaries

May 28, 2020, 14:01 PM

by ADCES Director of Advocacy Kate Thomas

On May 26, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model (“the Model”) for the 2021 plan year.

Beginning January 1, 2021, Part D sponsors participating in the Model will offer beneficiaries plan choices that provide broad access to multiple types of insulin, offered by participating insulin manufacturers, at a maximum $35 copay for a 30-days’ supply from the beginning of the year through the Part D coverage gap. As a result, beneficiaries who take insulin and enroll in a plan participating in the Model could save an average of $446 in annual out-of-pocket costs on insulin, or over 66 percent, relative to their average cost-sharing today.^[1] The goal of this Model is to keep out-of-pocket costs low, consistent, and predictable.

Insulin manufacturers and Part D sponsors applied to participate in the voluntary model when it was first announced in March. Reporting a robust response for participation, CMS anticipates beneficiaries will have Part D plan options in all 50 states, the District of Columbia, and Puerto Rico, through either a standalone prescription drug plan (PDP) or a Medicare Advantage plan with prescription drug coverage. Beneficiaries will be able to enroll during Medicare open enrollment, which is from October 15, 2020 through December 7, 2020, for Part D coverage that begins on January 1, 2021.

Part D sponsors that applied must submit their calendar year 2021 plan benefits to CMS by June 1, 2020 to designate their participation in the model. CMS anticipates releasing the premiums and costs for specific Medicare health and drug plans for the 2021 calendar year in September 2020, including final information on the model.

Beneficiaries will be able to find a Part D plan participating in the Model in the 2021 plan year through the Medicare Plan Finder on Medicare.gov during the annual open enrollment period, which begins on October 15, 2020 and ends December 7, 2020. CMS announced they will update the Medicare Plan Finder to include a filter to identify plans that will offer capped out-of-pocket costs for insulin in the model so beneficiaries can easily find those plans during open enrollment in the Fall. The Medicare Plan Finder allows users to shop and compare Medicare Advantage and Part D plans.

The savings would specifically apply to Medicare beneficiaries enrolled in the Model. The model appears to align with other recent savings announcements made by the insulin manufacturers. ADCES has developed an Insulin Cost Savings Resource Guide that details the manufacturer-specific patient assistance programs and savings opportunities available to those outside of the Medicare program, including those commercial insurance, those paying cash, and those that meet certain requirements.

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Sources:

1. May 26 Part D Senior Savings Model Announcement
2. March 11 Part D Senior Savings Model Announcement
3. ADCES Blog on Part D Senior Savings Model
4. ADCES Insulin Cost Savings Resource Guide

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