2023 Insulin Information
2023 Insulin Information
As long as an insulin is on the plan formulary, it will be no more than $35 for a 30 day supply
In a recent memo, CMS indicated they will not be updating plan finder at this time to show the actual client cost, but will continue to show what the plan originally submitted as their copay. There are a couple reasons for this. That original cost is what will affect when a client enters and leaves the donut hole. So Medicare is prioritizing accurately showing the coverage gap over accurately showing cost at the counter.
Additional Key Notes:
- Due to the timing of all of this, CMS is giving plans limited leeway through the end of March. It is possible a client may pay the full listed copay in Jan/Feb/Mar, but the carrier is required to reimburse anything over $35 within 30 days during that time. After April 1, the client cannot be asked to pay more than $35 for a 30 day supply of on-formulary insulin.
- There are several popular diabetic drugs such as Ozempic, Januvia, and Trulicity that are a newer class of drugs called incretin mimetics. These drugs are NOT insulin and are NOT capped at $35.
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