Medicare Plans to Offer $35 Monthly Cap on Insulin Costs

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Medicare Insulin Costs

In the last year, a few states passed laws to limit what people pay out of pocket for insulin, and all three major U.S. insulin manufacturers have announced new savings programs or product offerings in recent months.

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At the federal level, a number of bills have been introduced that would tackle insulin prices in different ways, such as by allowing importation of insulin from other countries or directly regulating insulin prices. But none of these proposals appear close to being passed by both houses of Congress or signed into law by President Donald Trump.

But it looks like federal action will bring some insulin price relief to at least some Americans starting next year. Earlier this week, Trump and other members of his administration — flanked by top executives from insulin manufacturers and representatives from insurance companies and diabetes advocacy groups — announced in a news conference that starting in January 2021, some Medicare Part D and Medicare Advantage plans will carry a monthly cap of $35 for out-of-pocket insulin costs. These plans will be available in all 50 states, DC, and Puerto Rico, and will cost about $17 more each month than other plans, as noted in an article on the announcement at NPR.

More than 3 million Medicare enrollees use insulin, the article notes. Seema Verma, administrator of the Centers for Medicare and Medicaid Services (the federal agency that oversees Medicare), stated in a conference call with reporters that the $35 cap would be estimated to lower out-of-pocket insulin costs for these enrollees by an average of about 66%.

She said in the conference call that if the new model of reducing out-of-pocket insulin costs proves to be successful, her agency would consider forging agreements with insurers and pharmaceutical companies that cover other categories of drugs. These agreements don’t go nearly as far as many members of Congress would like, and some Democrats have proposed letting Medicare directly negotiate drug prices with manufacturers — something that Medicare isn’t allowed to do under current law, but is the longstanding practice of certain other federal agencies that provide health benefits, including the Veterans Health Administration.

But for now, says Verma, the new Medicare plans can act as “a foundation and a platform to fixing some of the problems that we have in the Part D plan. It’s time for that program to be updated.”

Want to learn more about saving money on insulin? Read “Insulin Prices: Four Ways to Pay Less” and “Cheaper Insulin: Older Insulins May Be Answers to High Prices.”

Quinn Phillips

Quinn Phillips

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A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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