by Leslie Small
The Trump administration on May 26 shared new details about a
program that offers diabetic seniors access to a variety of insulin products
for a maximum $35-per-month copay.
More than 88 health insurers offering about 1,750 standalone
Medicare Part D Prescription Drug Plans and Medicare Advantage plans with
prescription drug coverage have now applied to participate in the Part D Senior
Savings Model, which CMS unveiled in mid-March. Medicare beneficiaries in all
50 states, the District of Columbia and Puerto Rico will be able to enroll in a
participating plan during the Medicare open enrollment period that lasts from
Oct. 15 to Dec. 7, 2020, for Part D coverage that begins on Jan. 1, 2021.
That "widespread voluntary participation" from health
plans "was essential for the program's success," says Marc Guieb,
Pharm.D., a consultant at Milliman, Inc. Still, "many plans were hesitant
to participate in the inaugural year of this program due to uncertainty around
its financial impact," he says. "It is likely that, in future years,
more plans will jump on the bandwagon."
CMS estimates that Medicare beneficiaries who use insulin and
join a plan participating in the Part D Senior Savings Model could save an
average of $446 annually on out-of-pocket insulin costs, or 66%. Three insulin
manufacturers — Eli Lilly and Co., Novo Nordisk Inc. and Sanofi U.S. — have
agreed to participate.
On the one hand, the concept of a fixed insulin copay should be
attractive to seniors and can improve medication adherence, says Brian
Anderson, a principal at Milliman. Still, "the benefit coordination and
claims processing is going to be tricky," he suggests, adding that
"the pharmacy reimbursements, manufacturer payments, application of the
Part D benefit phases and reinsurance will all come into play."
"Overall, this has the opportunity to improve the Part D
benefit and drive formulary competition from a cost standpoint," Anderson
concludes.
America's Health Insurance Plans (AHIP) gave the program a
glowing assessment. "Innovative voluntary programs like this Part D Senior
Savings Model are an excellent example of public-private partnerships where
everyone wins, but especially patients," AHIP President and CEO Matt Eyles
said in a statement released May 26.
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