Insulin Savings Program
The insulin savings program is also called the Medicare senior savings model (SSM) It was put into effect for the 2021 Medicare AEP. The program is available with a number of Medicare insurance plans (MAPD and PDP) Participation varies by company and state. It is important to know which MAPD and PDP plans participate to find the best savings for clients
How the program lowers insulin costs
The carriers participating in the program will cap insulin costs at $35 per month. The cap works with a number of insulin brands and still works in the coverage gap. As a result, clients can save substantial money throughout the year utilizing the program. In addition, the savings are even greater for those that commonly go into the Medicare Part D coverage gap “Donut hole”. Not all drug plans (PDP and MAPD drug coverage) provide the cost protection of the Insulin savings program. It is important to know the carriers that do participate as a result.
Insulin Savings program Medicare drug phases covered
The program applies throughout all Medicare benefit phases: The deductible phase, Initial coverage phase, coverage gap and the catastrophic phase. Part D savings model chart As a result, a deductible would not need to be met for insulins included in the SSM. This is the same during the gap phase as well. The cost of the insulin would likely go down below the $35 fixed cost once the catastrophic phase was entered.
Types of insulin covered
Not all insulins are covered by all drug plans. Plans participating in the insulin savings program will only provided the savings on insulins on their formulary. Some commonly taken name brand insulins are now available in generic form. The generics are currently very expensive however. They also are not part of the SSM and the $35 cap. As a result, the costs come out better taking the name brand version at this point. Below are some common name brand insulins that may be part of the SSM with MAPD and PDP plans.
Insulin costs without SSM
Most of the name brand medications above are very expensive without the savings provided by the insulin savings program. In addition to the monthly cost there is also the donut hole and coverage gap. In the gap, the cost of the drugs will increase sharply per month. This is especially true with some of the newer brands such as Toujeo, Levemir and Tresiba.
Use Sunfire and Connect4Medicare to check costs
We give agents access to both Sunfire and Connect4Medicare “Connecture” at no cost. Both platforms will allow agents to run medication costs. In addition, they can see which plans will cap insulin costs at $35 a month.