Insulin users beware: your Medicare drug plan may drop your insulin. What it means for you

[Duaine]

With Medicare annual open enrollment about to close on Dec. 7, Medicare experts are discovering many insurance plans are dropping some insulin coverage in 2024.

In an informal survey of 22 Medicare plans, 10 plans are dropping at least one insulin from their formulary, according to Diane Omdahl, founder of 65 Inc., which provides Medicare enrollment guidance through fee-for-service, one-on-one consultations. Four plans are dropping four or more different insulins, she said.

If you’re banking on the $35 out-of-pocket insulin cap to continue saving money next year, you must check your plan to see if your insulin is still covered. Only if your drug plan covers your insulin will you receive the $35 cap, according to the Centers for Medicare & Medicaid Services.

[EXTERNAL LINK] - Medicare plans are dropping insulin. If you don't act, it may cost you

 

[axeman462]

On a similar note, found out this past week that Levimir will no longer be manufactured

 

[steveadlman]

With Medicare annual open enrollment about to close on Dec. 7, Medicare experts are discovering many insurance plans are dropping some insulin coverage in 2024.

In an informal survey of 22 Medicare plans, 10 plans are dropping at least one insulin from their formulary, according to Diane Omdahl, founder of 65 Inc., which provides Medicare enrollment guidance through fee-for-service, one-on-one consultations. Four plans are dropping four or more different insulins, she said.

If you’re banking on the $35 out-of-pocket insulin cap to continue saving money next year, you must check your plan to see if your insulin is still covered. Only if your drug plan covers your insulin will you receive the $35 cap, according to the Centers for Medicare & Medicaid Services.

[EXTERNAL LINK] - Medicare plans are dropping insulin. If you don't act, it may cost you

I have found this to be true for Lantus.

 

[somarco]

Due to the shifting nature of the pharmaceutical world, formularies change often. As new drugs are approved and more information about new uses for current drugs becomes available, pharmacy and therapeutic committees meet regularly to review their drug formularies and make adjustments.

This means that drugs can be added or removed from the drug formulary at any time. They can also move specific medications from tier to tier depending on several factors.
[EXTERNAL LINK] - Can My Drug Formulary Change? - Patient Advocate Foundation

 

[Chazm]

Not to state the obvious, but MAPD plans aren’t dropping it. Buuut I’m in FL

 

[Duaine]

Levimir will no longer be manufactured

[EXTERNAL LINK] - Novo Nordisk Discontinuing Long-Acting Insulin Product Levemir.

 

[billyb]

Had a client on Novolog and Tresiba. UHC will not cover Novolog.

 

[somarco]

Had a client on Novolog and Tresiba. UHC will not cover Novolog.

Plans usually don't cover brand when there is a generic. Insulin aspart is generic Novolog and UHC will cover it on a PDP @ $35.

Or, get the doc to write a new Rx for an insulin that is on the formulary

 

[Russ]

Means I can use the Florida SEP thru February 28th because of the war in Israel. Uplines and companies advertise it daily in emails. But we have to wait for the potential client to bring it up. Yeah...right.

Sorry I hijacked the thread for one post.

 

[DonP]

Means I can use the Florida SEP thru February 28th because of the war in Israel. Uplines and companies advertise it daily in emails. But we have to wait for the potential client to bring it up. Yeah...right.

Sorry I hijacked the thread for one post.

Duals/lis sep is moving to monthly in 2024 or by aep 2025 . I’ve used dst code mid yr to move orginal medicare people to mapd. Call centers use the state pharmaceutical sep all the time to move people . In all the apps I’ve written the last few yrs I’ve only had 1 sep refused .