Carriers and Plans Participating in CMS Model to Save Consumers on Insulin Costs

Beginning with the 2021 plan year, select Part D sponsors will offer beneficiaries PDPs that “provide supplemental benefits for insulin in the coverage gap phase of the Part D benefit.”

The new 2021 Part D Senior Savings Model from the Centers for Medicare & Medicaid Services (CMS) weighs the effects of offering those who are eligible for Medicare more choices of Part D plans that would lower out-of-pocket costs of insulin for members to a maximum cost of $35 for a one-month supply. High insulin costs can negatively affect your clients, being detrimental to their health and their finances. As you prepare for upcoming appointments with your diabetic clients, consider what participating plans you have in your portfolio. Adding one or several of these plans to your portfolio could greatly impact your clients.

Who’s Participating?

In 2021, there will be 1,635 prescription drug plans participating in the Part D Senior Savings Model, including both MAPDs and PDPs. The model will have 76 participating Part D sponsors. Through this, about 13.2 million enrollees will be covered across all 50 states, Washington, D.C., and Puerto Rico.

Those who are eligible for Medicare will be able to see the PDPs that are part of the model for the 2021 plan year by visiting the Medicare Plan Finder on Medicare.gov during this year’s AEP. A new “Insulin Savings” filter can be applied on the plan finder to narrow down your search.

In order to incentivize Part D sponsors to take part in the model, CMS is giving Part D sponsors the option of “additional risk corridor protection” for 2021 and 2022 for plan benefit packages that have a high number of diabetic patients who are dependent on insulin.

Why the New Model?

More than 3.3 million Medicare members use at least one type of insulin, according to this notice from the Centers for Medicare & Medicaid Services. That explains why access to insulin is so critical to not only the American public, but specifically, Medicare beneficiaries.

For many of those 3.3 million people, whether or not they have access to the insulin they need is a huge factor in the quality of their health. Not having access can potentially lead to heart attacks, foot ulcers, kidney failure, or vision loss. When the cost of insulin becomes a financial burden on those who need it, they are even more at risk for these complications.

The new Part D Senior Savings Model was created in response to President Trump’s plan to lower the cost of insulin. For carriers with products participating in this model, a one-month supply of insulin would not cost any more than $35. The model also intends to decrease Medicare expenses by offering a variety of supplemental benefits to cover costs such as copays and initial coverage. The Part D Senior Savings Model aims to provide beneficiaries with higher quality care and will benefit those who have either a PDP or an MAPD plan.

When Will These Changes Take Place?

Beginning with the Annual Enrollment Period for the 2021 plan year, participating Part D sponsors will offer beneficiaries PDPs that “provide supplemental benefits for insulin in the coverage gap phase of the Part D benefit.” The participating pharmaceutical manufacturers will pay the 70 percent discount for the insulins included in the Part D model. Those payments would then be assessed under the model before the application of supplemental benefits.

Under the new model, Part D sponsors will offer beneficiaries more choices that will allow them access to more types of insulin. With the maximum copay being $35, the model projects members saving an average of $446 (or over 66 percent) in annual out-of-pocket costs on insulin.

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Additional information on the 2021 Part D Senior Saving Model, including fact sheets and press releases, can be found linked at the bottom of the CMS report.

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