Oakland Southfield Physicians

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The Centers for Medicare & Medicaid Services (CMS) Launches Groundbreaking Model to Lower Out of Pocket Expenses for Insulin

Posted: 10/13/2020

CMS announced a new Model for 2021 called the Part D Senior Savings Model. This voluntary Model tests the impact of offering beneficiaries an increased choice of enhanced alternative Part D plan options that offer lower out-of-pocket costs for insulin.

Beginning January 1, 2021, Part D sponsors participating in the Model will offer beneficiaries plan choices that provide broad access to multiple types of insulin, at a maximum copay of $35 each for a month’s supply in the deductible, initial coverage, and coverage gap phases of the Part D benefit. As a result, beneficiaries who use insulin and enroll in a plan participating in the Model should save an average of $446 in annual out-of-pocket costs on insulin, relative to their average cost-sharing today. This predictable copay will provide improved access to and affordability of insulin in order to improve management of beneficiaries who require insulin as part of their care.

Beneficiaries will be able to find prescription drug plans that are participating in the Part D Senior Savings Model in the 2021 plan year through the Medicare Plan Finder on Medicare.gov during the annual open enrollment period (October 15–December 7). CMS will add a new “Insulin Savings” filter to easily display plans that will offer capped out-of-pocket costs for insulin.

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