Insulins Will Be More Affordable for Seniors in 2021!
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
Insulin can be a lifesaving medication for people living with diabetes. It's been around for a long time, but in recent years its cost has skyrocketed. Reasons for the price hikes are unclear to most experts, and likely are the result of many factors. But regardless of the reasons, the cost of insulin has gotten so high that many people can't purchase their prescriptions regularly (or at all).
What's so important about insulin?
Insulin helps the body regulate blood sugar. In those without diabetes, the pancreas produces insulin when it's needed, for example right after a meal. Insulin clears sugar from the bloodstream and allows it to get into cells that need it for fuel. Without insulin, blood sugar levels remain high after eating, while cells that need it aren't able to function properly. Over many years, uncontrolled blood sugar can lead to major health problems like kidney disease, heart problems, nerve pain, eye damage, and more. The high cost of insulin is an urgent public health problem.
Diabetes affects people of all ages, but its prevalence is highest in those 65 and older. In that age group, about one in four has diabetes. And of those enrolled in Medicare, about 3.3 million require insulin to stay healthy. Bringing down the cost for patients to purchase their insulin prescriptions increases the chance that their blood sugar will be controlled. At the same time, it decreases the risk of long-term complications of diabetes and their resulting healthcare expenses, and will allow people to lead more active lives.
The Part D Senior Savings Model
Starting in 2021, Medicare is rolling out the "Part D Senior Savings Model". This is a unique program, designed to decrease the out-of-pocket cost of insulin for those with Medicare Part D insurance plans. It's also in effect for those who have Medicare Advantage Plans with Part D prescription insurance. Here's a snapshot of how it works.
Insurers who offer Medicare Part D plans or Medicare Advantage Plans with Prescription Coverage were given a choice whether to offer a Senior Savings Plan earlier this year. Some did, some didn't. Those who did promised to keep the out-of-pocket cost of a number of commonly-used insulins at $35 per one-month supply. That'll be the co-pay all year long. If the policy has a deductible at the beginning of the year, the co-pay is $35. During regular coverage, the co-pay is $35. If the "donut hole" is reached, the co-pay is still $35. This allows those who need insulin to predict how much they'll pay every month. No more surprise increases because of a deductible or the "donut hole". That will be a huge savings for many people!
How can you take advantage of this new program?
Not all insurers are offering this savings. And even those who are don't have to offer it on every type of policy. The only way to know if a policy covers it is to check it out for yourself. Here are some ways to do that.
Go to www.Medicare.gov and click on "Find 2021 Health & Drug Plans". You can set up an account or just browse plans without one. It'll ask you a series of questions to determine what you're looking for. Be sure to check the box that says "include drug costs". Then, enter in all the medications you take and choose which pharmacies you'd like to compare. Now you'll see all the plans that are available to you. This is where you can narrow it down to just those plans participating in the Senior Savings Program. To do that, click on the "filter" button at the top right of the screen, check the box that says "insulin savings", then click "apply filters". Now you'll see only those plans that have the lower insulin cost. You can compare these plans to each other and to your current plan to see if switching would benefit you.
If your pharmacist offers assistance with Medicare enrollment, make an appointment to go through options with them. They'll likely use the same medicare.gov website, but may have some tricks to help get more detailed information about coverage.
Call Medicare directly at 1-800-Medicare for telephone assistance.
Contact a Medicare insurance expert to help you find the right plan. A trusted colleague, Debbie Kuiawa, is located in the Southeast Michigan area and can be found at www.insurewithDebbieK.com. If you're in another area of the United States she'd be happy to help you find an expert locally as well.
Finally, you can contact us at BetterMyMeds for assistance in finding a Medicare Prescription Drug Plan. We're ready to help you find available plans and think through which ones fit your priorities for coverage.
Medicare Open Enrollment is NOW!
Don't wait -- open enrollment period started October 15 and ends on December 7. Even if you don't use insulin, it's best to check insurance options regularly. There can be changes in the list of covered drugs, co-pays, deductibles, and premiums starting in January. Best to check ahead of time so there are no surprises in 2021. For more information on Medicare options, check out our post from last year, Understanding Medicare Health Insurance.
As always, we welcome your comments and questions below, or send a message directly to us at BetterMyMeds. Our goal is to help you get the best value from your medications (and your prescription insurance!).
Such important information. Thanks for posting this, Betty! Hopefully this will reduce the cost-barriers for many patients.