Part D Savings Model for Insulin
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:
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