CMS Announces Voluntary Part D Program to Reduce Insulin Out-of-Pocket Costs for Some Enrollees

In a May 26, 2020 press release, the Centers for Medicare & Medicaid Services (CMS) “announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year. Across the nation, participating enhanced Part D prescription drug plans will provide Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply, from the beginning of the year through the Part D coverage gap.”

According to Juliette Cubanski of the Kaiser Family Foundation (via Twitter), this figure represents approximately 50% of enhanced plans in 2020, including Medicare Advantage and stand-alone Part D drug plans (but we don’t yet know how many of each type of plan will be available; there are currently about 3,200 enhanced MA plans and 570 enhanced stand-alone plans).

While Part D enrollees who use insulin could see savings under this model, they may have to switch plans and/or switch insulin products in order to see such savings. According to Cubanksi, important metrics to watch for include:

• What do monthly premiums look like for participating Part D enhanced plans in 2021 relative to other enhanced plans and basic plans (currently enhanced plan premiums are roughly twice the level of premiums for basic plans); and
• How many insulin products does each participating plan actually offer at the $35 flat copay?

STAT News described the change as “modest at best: Drug makers agreed to participate in a minor, voluntary Medicare program that will likely only provide a limited discount on insulin for a small subset of the 60 million seniors with Medicare coverage.” Further, “[t]he rollout left drug pricing reform advocates disappointed and experts scratching their heads.”

Further, Axios offered the following: “Reality check: Medicare's new model will bring some financial relief next year to patients who are struggling to afford their insulin. But experts say it doesn't change actual prices and gives cover to avoid more serious drug pricing reforms during the coronavirus pandemic.”