Medicare Insulin $35
The Medicare Insulin $35 copay Part D Senior Savings Model (SSM) will continue in 2023. The recently passed program called the “Insulin Now Act” will continue a program that began in 2001. The program puts a cap of $35 for a one month supply of certain brands and types of Insulin.
Part D costs with the program
The cost for Insulin in the program will be capped at $35 per month for a one month supply. There are a number of pharmaceutical manfaturers participating in the program. (See list below) The fixed cost will provide substantial savings to those with Part D drug plans (Either through a stand alone Part D plan or a Medicare Advantage plan). The Insulin prescriptions will not be subject to the usual cost aspects of a Medicare Part D plan. This includes any initial plan deductible, Initial coverage phase and Part D Coverage Gap. It does not apply during the catastrophic coverage phase so the cost may change at that time.
The Medicare Insulin $35 copay SSM: Participating Pharmaceutical Manufacturers
1. Eli Lilly and Company
2. MannKind Corporation
3. Mylan Specialty L.P.
4. Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
5. Sanofi-Aventis U.S. LLC
Medicare Insulin $35 copay: Quoting plans
Please note; the $35 program does not cover every type of insulin. Some of the more expensive name brand drugs for diabetics such as Jardiance or Trulicity will not be capped at $35. You can access a list of the Insulins that will be capped at $35 Part D insulin saver program list 2023
Starting with the 2023 Medicare AEP, drug comparisons on a number of systems will reflect the $35 cost cap on Insulin. Online comparison sites such as Connecture, Sunfire and Medicare.gov plan finder will all reflect the new cap of $35.
Changes to Medicare for 2023
In addition to the Medicare Insulin $35 copay cap, there will be other changes to Medicare for 2023. There are the usual changes to the Medicare premiums, deductibles and copays. In addition, there is a new type of Medicare Part B and new rules for those with delayed Part B enrollments.