By Karena Yan

That led to a short video that played during a May 26, 2020, briefing by President Donald Trump in the Rose Garden, as part of the announcement of a new $35 insulin copay cap for certain Medicare.

• Insulin copays for beneficiaries in Medicare Part D drug plans could max out at $35 a month in 2021 under a voluntary model unveiled Tuesday by the Centers for Medicare & Medicaid Services.
• Verma, head of the Centers for Medicare and Medicaid Services, said 1,750 insurance plans that offer drug coverage to Medicare recipients have agreed to provide insulin for a maximum copay of $35 a.

The program is predicted to save older Americans hundreds of dollars per year

The Centers for Medicare and Medicaid Services (CMS) has announced a new pilot program that will cap the monthly cost of insulin at $35 for Americans on Medicare, a federal health insurance program for people 65 years or older. The program, which will go in to effect in 2021, is predicted to save older Americans an average of $446 a year.

All three insulin manufacturers – Sanofi, Eli Lilly, and Novo Nordisk – have agreed to participate in the pilot program. During a time of much public outrage over insulin prices, which doubled between 2012 and 2016 and continue to rise today, drug companies have been scrambling under the pressure. In addition to offering insulin discount cards and other forms of copay assistance, insulin manufacturers are hoping to use this program to make insulin more affordable for Medicare recipients, more than one-third of whom say cost has impacted their purchase of insulin.

However, because the program only applies to Medicare recipients, some critics deem the insulin proposal as too little, too late.

How Much Is A Bottle Of Insulin Without Insurance

“It still leaves huge numbers of people with diabetes who rely on insulin in the same place they were before — rationing and suffering,” said Elizabeth Pfiester, the founder and executive director of patient advocacy group T1International. “Many of the deaths we are seeing from rationing are young people without insurance, so we need federal action that provides immediate relief and long-term solutions for everyone.”

Moreover, while over 3.3 million Medicare recipients use at least one form of insulin, the pilot program only applies to “enhanced” Medicare drug plans, which have more extensive drug coverage but have more expensive premiums. Thus, even among Medicare beneficiaries, not everyone can benefit from the new policy.

The program it is predicted to save the government $250 million over five years in direct health plan spending. However, affordable access to insulin will likely lead to fewer hospitalizations and diabetes complications, meaning federal savings are likely to surpass that projection.

This pilot program is a nod in the right direction, and three other states – Colorado, New Mexico, and Virginia – have already mandated a cap on insulin prices. However, these policies still do not solve the larger structural issues surrounding insulin affordability. The program has no impact on younger people on high-deductible health plans, who pay full price for insulin until they meet their deductible, or individuals with no insurance at all.

How Expensive Is Insulin Without Insurance

Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool, GetInsulin.org.

On March 11, the Centers for Medicare & Medicaid Services (CMS) launched a new plan for some Medicare Part D participants to pay a maximum $35 copay for their monthly supply of insulin.

The program is called the Part D Senior Savings Model and applies to participating Part D enhanced plans through Medicare. These enhanced plans have slightly higher premiums (an average of $49.32 per month versus $32.09 per month) than the standard Part D plan, but offer broader prescription drug coverage.

Only insulins created by participating manufacturers will be included, but the intent is for all types of insulin to be covered, including long-acting, intermediate-acting, short-acting, and rapid-acting. As of March 11, Lilly has signed on to participate in this program once it launches on January 1, 2021. CMS is currently inviting other manufacturers to apply by March 18, 2020 to be included in the 2021 plan.

A copay cap provides consistent and predictable access to insulin, allowing insulin-dependent people with diabetes the ability to create reliable budgets for their medication needs. This is different from the current model in which Medicare Part D beneficiaries are often faced with fluctuating prescription costs month to month.

CMS reports that those enrolled in a participating plan should save “an average of $446 in annual out-of-pocket costs for insulin.” While the new model applies to a small part of the population, it reduces a significant burden for some of the most vulnerable members of the population: insulin dependent people with diabetes over the age of 65. The plan also creates a model for how copay caps may be done in future.

Insulin rationing due to unpredictable or inaccessible costs is dangerous for everyone with insulin-dependent diabetes, potentially leading to complications such as nerve damage, amputation, diabetic ketoacidosis and even death.

More information on the new Part D Senior Savings Model can be found here.