Insulin for Medicare beneficiaries is $35 . . . except when it isn't . . .
Since January 1, 2023, there has been a cap on insulin for Medicare beneficiaries.
The cap applies to those who have Part D prescription drug coverage, whether through a stand-alone plan or as part of a Medicare Advantage plan. (The cap also applies to insulin administered via a pump under Part B, medical insurance.)
Part D enrollees will pay no more than $35 for “an insulin that is included on a Part D sponsor’s formulary.”
The plan’s deductible does not apply.
The cost is the same at preferred or standard pharmacies
Part D plans can add or remove medications from their plan during the year.
When entering a drug such as Lantus or Novolog, a pop-up box notes, “Your drug has a generic” that may cost less. In the case of insulin, if the generic is covered, it won’t cost less but chances are the plan will save money. And that can be a factor in what’s happening with insulin coverage.
Since January 1, 2023, there has been a cap on insulin for Medicare beneficiaries.
The cap applies to those who have Part D prescription drug coverage, whether through a stand-alone plan or as part of a Medicare Advantage plan. (The cap also applies to insulin administered via a pump under Part B, medical insurance.)
Part D enrollees will pay no more than $35 for “an insulin that is included on a Part D sponsor’s formulary.”
The plan’s deductible does not apply.
The cost is the same at preferred or standard pharmacies
Part D plans can add or remove medications from their plan during the year.
When entering a drug such as Lantus or Novolog, a pop-up box notes, “Your drug has a generic” that may cost less. In the case of insulin, if the generic is covered, it won’t cost less but chances are the plan will save money. And that can be a factor in what’s happening with insulin coverage.
