Insulin for Insulin Pumps start mid 2023

Duaine

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The $35 copayment for injectable insulin products goes into effect on January 1 and July 1 for insulin pump users. When insulin-using beneficiaries now check the plan finder, the price may be thousands of dollars per year rather than the maximum $420 allowed by law. Erroneous pricing might also skew the costs of other medications, which vary based on the patient’s coverage phase. For instance, after the plan and the patient spends a total of $4,660 on medications in the next year, the member pays no more than 25 percent of the cost for non-insulin drugs.

[EXTERNAL LINK] - Medicare Plan Finder Inaccurate For 2023: What You Need To Know - The American Retiree
 
The $35 copay is not universal across the board. The $35 copay only applies if the brand & type of insulin you buy is included in your PDP formulary. It is entirely possible for someone, not on a pump, to pay more than $420 if they fail to understand how this works.

If they can't/won't change to a PDP that includes a $35 copay, then they need to ask their doc to write a new Rx for a formulary brand that has the $35 copay.
 
Also, if someone is on a Medicare qualified CGM, with or without a pump, they should be able to run the insulin and other items through Part B.

This is a good summary about Freestyle Libra and Dexcom cgm including what is covered by Part B. Also refer to internal linked article re supplies.

[EXTERNAL LINK] - Will Medicare Cover FreeStyle Libre and Other Glucose Monitors? - GoodRx

People with diabetes can have substantial out-of-pocket expenses for insulin as well as medical care items such as a glucometer and test strips; continuous glucose monitor with sensors and transmitters; and an insulin delivery device with its supplies.
[EXTERNAL LINK] - What Diabetic Supplies Do I Need, and What Are the Costs? - GoodRx
 
Do insulin pumps help, or add to someone's bad diabetic choices?

I have a couple of friends who use the pump and and have had conversations with others about folks deciding to just jump up their pump as opposed to making important decisions regarding eating habits.

Not asking for an argument, just was wondering what others opinions on this might be. :)
 
Do insulin pumps help, or add to someone's bad diabetic choices?

I have a couple of friends who use the pump and and have had conversations with others about folks deciding to just jump up their pump as opposed to making important decisions regarding eating habits.

Not asking for an argument, just was wondering what others opinions on this might be. :)

Insulin pumps require a doc prescription. To be covered by Medicare you must meet certain criteria
You may be a candidate for insulin pump therapy if you:
Are taking insulin injections.
Have an A1C greater than 7%
Forget to take your insulin injections.
Have frequent high or low blood sugars.

Some folks have trouble regulating their insulin and may benefit from a CGM and pump. (You may qualify for Medicare coverage for a CGM even if you are not on a pump).

Many can benefit from a CGM without needing a pump (which is very expensive).
 
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