Medicare Part D Savings Model for Insulin

CMS has released a list of Pharmaceutical Insulin Manufacturers that will participate in the Part D Senior Savings Model in 2021.

There are currently three manufacturers involved:

Eli Lilly and Company
Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
Sanofi-Aventis U.S. LLC

The Part D Senior Savings Model is part of CMS’ ongoing efforts to keep insulin co-pays at a $35 maximum for the consumer. This is an ongoing list that is subject for updates, you can view the full list here. You can also view the full details of the saving model test here.

Carrier Participation in the Part D Savers Program:

Please note that the Medicare Carrier and their specific plan, along with the Manufacturer, all have to participate or opt-in to this in order for the client to receive the benefits of the Senior Savings Model.

Aetna/Silverscript
- Will only be participating in the Florida market on MAPD plans.
Anthem
- Will not be participating.
Cigna
- They will be offering the program on three PDP plans in 2021. These plans include:
  - Cigna Secure-Extra Rx, which offers a $0 copay for select insulins through the coverage gap at preferred pharmacies
  - Express Scripts Medicare – Choice, which offers a $0 copay for select insulins through the coverage gap at preferred pharmacies
  - Express Scripts Medicare – Saver, which offers a $35 copay for select insulins through the coverage gap regardless of pharmacy type
Humana
- Information has not been released yet.
Mutual PDP
- Information will not be released until 10/1/2020.
UnitedHealthcare
- Only specific plans are participating. Those plans include:
  - Non-SNP plans
  - Chronic SNP plans
  - Preferred PDP plan
Wellcare
- Information has not been released yet.

Part B usually covers more than part D for Diabetes. It can also be considered DME, but using it as a DME you have to make sure it is a Medicare approved DME supplier.

Learn more below:

How insulin is covered: http://www.medicare.gov/coverage/insulin.html
Diabetes Supplies Publication: https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf?
How Diabetes is covered with part B: http://www.medicare.gov/coverage/diabetes-supplies-and-services.html
Blood Sugar Monitors: http://www.medicare.gov/coverage/blood-sugar-monitors.html
Test Strips: http://www.medicare.gov/coverage/blood-sugar-test-strips.html
Finding a Diabetic Supplier that is approved for DME: https://www.medicare.gov/supplierdirectory/search.html

Sources:

https://innovation.cms.gov/files/x/partd-seniordav-ndclist.pdf

https://innovation.cms.gov/innovation-models/part-d-savings-model

https://www.cms.gov/newsroom/press-releases/trump-administration-announces-historically-low-medicare-advantage-premiums-and-new-payment-model

Medicare Part D Savings Model for Insulin

CMS has released a list of Pharmaceutical Insulin Manufacturers that will participate in the Part D Senior Savings Model in 2021.

There are currently three manufacturers involved:

Eli Lilly and Company

Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.

Sanofi-Aventis U.S. LLC

The Part D Senior Savings Model is part of CMS’ ongoing efforts to keep insulin co-pays at a $35 maximum for the consumer. This is an ongoing list that is subject for updates, you can view the full list here. You can also view the full details of the saving model test here.

Carrier Participation in the Part D Savers Program:

Please note that the Medicare Carrier and their specific plan, along with the Manufacturer, all have to participate or opt-in to this in order for the client to receive the benefits of the Senior Savings Model.

Aetna/Silverscript

Will only be participating in the Florida market on MAPD plans.

Anthem

Will not be participating.

Cigna

They will be offering the program on three PDP plans in 2021. These plans include:

Cigna Secure-Extra Rx, which offers a $0 copay for select insulins through the coverage gap at preferred pharmacies

Express Scripts Medicare – Choice, which offers a $0 copay for select insulins through the coverage gap at preferred pharmacies

Express Scripts Medicare – Saver, which offers a $35 copay for select insulins through the coverage gap regardless of pharmacy type

Humana

Information has not been released yet.

Mutual PDP

Information will not be released until 10/1/2020.

UnitedHealthcare

Only specific plans are participating. Those plans include:

Non-SNP plans

Chronic SNP plans

Preferred PDP plan

Wellcare

Information has not been released yet.

Part B usually covers more than part D for Diabetes. It can also be considered DME, but using it as a DME you have to make sure it is a Medicare approved DME supplier.

Learn more below:

How insulin is covered: http://www.medicare.gov/coverage/insulin.html

Diabetes Supplies Publication: https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf?

How Diabetes is covered with part B: http://www.medicare.gov/coverage/diabetes-supplies-and-services.html

Blood Sugar Monitors: http://www.medicare.gov/coverage/blood-sugar-monitors.html

Test Strips: http://www.medicare.gov/coverage/blood-sugar-test-strips.html

Finding a Diabetic Supplier that is approved for DME: https://www.medicare.gov/supplierdirectory/search.html

Sources:

Recent Posts

Agent Update Memo — September 2026

Stay Connected this AEP with AMP

2027 Medicare Advantage and Part D Star Ratings

Sidebar Setup

Agent Tools

The Company

Sign In

Your username is the email you registered with.