Making Insulin More Affordable for People with Medicare More than 3.3 million people with Medicare use one or more of the common forms of insulin every day. Unfortunately, the cost of insulin has nearly tripled over the past ten years, from about $100 to $300 a vial, and out-of-pocket costs for the drug for people with Medicare can significantly fluctuate from month to month, making budgeting and management of a person’s diabetes more difficult. Starting October 15, 2020, people with Medicare will be able to enroll in a Medicare drug plan that offers insulin for no more than a $35 copay for a month’s supply. Coverage will begin on January 1, 2021. While all plans that are participating in Medicare’s new “insulin savings model” guarantee that your cost-sharing is capped at $35 for a month’s supply of insulin, some plans may offer even lower copays. Participating plans cover different types and brands of insulin, and it’s important to check each plan’s formulary to find out your exact cost, starting in the deductible phase, and going through the initial coverage, and coverage gap phases of your Medicare drug benefit. By enrolling in a participating plan, people with Medicare may save hundreds of dollars per year on your out-of-pocket costs for insulin, and you’ll always know exactly what you’ll be paying each
As you begin to educate your residents regarding the open enrollment period to review and select their Part D plans, Partner Care Pharmacy has useful tools to share. Also, Starting October 15, 2020 Medicare beneficiaries will be able to enroll in a Medicare drug plan that offers insulin for no more than $35 copay per month. For those residents currently on insulin therapies it is important to review that coverage. Go to this website Medicare.gov/plan-compare to log-in and compare Part D plans. Have your list of medications available before you log-in. Click the links below for Medicare Part D resources Open Enrollment Video Medicare Open Enrollment flyer – English Medicare Open Enrollment flyer – Spanish 2021 Insulin Saving Model – FAQ
Medicare Update 2020 The Centers for Medicare & Medicaid Services (CMS) issued the 2020 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. The 2020 deductible, coinsurance and base premium rates are: 2020 Part A – Hospital insurance Deductible: $1,408.00 Coinsurance • $352.00 a day for 61st-90th day • $704.00 a day for 91st-150th day (lifetime reserve days) • $176.00 a day for 21st-100th day (skilled nursing facility coinsurance) 2020 Part B – Supplementary medical insurance (SMI) Under Part B of the Medicare supplementary medical insurance (SMI) program, enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute. Standard premium: $144.60 a month Deductible: $198.00 a year Coinsurance: 20% The Centers for Medicare & Medicaid Services has set the Part A deductible, for hospital stays, at $1,364 for 2019. The coinsurance per day in the hospital for 2019 is $341 from the 61st day until the 90th day. Part B deductible, for doctor and lab tests, is $185. Medicare Part B covers one flu shot per season, with no copay or deductible. For Skilled Nursing Facility stays, the coinsurance is $170.50 per day for days 21 to 100. This information is for Medicare,
Medicare Part D Plan Open Enrollment Every October 15 through December 7th Medicare Part D plans have Open Enrollment. The programs begin on January 1st. Medicare Part D is prescription drug coverage with a formulary of prescription drugs, managed by a plan sponsor. If a person participates in Medicare Part A or Part B, then the Part D enrollment is voluntary. If a person has Medicaid, then they must enroll in a Part D plan, or one will automatically be assigned. Medicaid coverage helps with costs of premiums, deductibles and co-pays. FLORIDA APPROVED PART D PLANS FOR 2020 SilverScript Choice Wellcare Classic Cigna Healthspring RX Secure (new for 2020) Clear Spring Health Value RX (new for 2020) Basic Plan for the Average Person Monthly premiums average $30.00 per month Annual deductible is $435.00 Co-pays for prescriptions up to 75% of the cost of drugs (depends on the drug) “Donut Hole” – is a gap in prescription coverage Coverage for drugs stops at $4,020 Beneficiary is responsible for 100% of drug costs from $4,020 until $6,350 out of pocket Once the annual cost of drugs reaches $6,350, Medicare Part D pays 95% of costs During Open Enrollment Oct – Dec Letters will be mailed to all “choosers” regarding their status The designated person that choose a plan any year since
Question: Why do drug prices change without any warning, like the EpiPen increase of 400% overnight? Answer: Dramatic drug price increases can be devastating for patients when their insurance denies the drug and they can’t afford to pay out of pocket. The company that sells EpiPen has come under major scrutiny for their decision to jak up their prices, but they have a monopoly on the auto injector epinephrine dosage system. Since there is not other drug to compete they can set the price at $500 for a drug that cost about $1. Price increases can be a result of shortages, but it also can be a business strategy of pharmaceutical companies that acquire old drugs and promptly raise their prices to help their bottom line. Another example is Doxycycline, an antibiotic, that went form $20 a bottle to $1,849. Partner Care Pharmacy will alert our clients when drug prices soar without warning and offer an alternative therapy.
6 ways to lower your coverage gap costs Consider switching to generics or other lower-cost drugs. Talk to your doctor to find out if there are generic or less-expensive brand-name drugs that would work just as well as the ones you’re taking now. You might also be able to save money by using mail-order pharmacies. Find health & drug plans. Choose a plan that offers additional coverage during the gap. There are plans that offer additional coverage during the coverage gap (Medicare prescription drug coverage), like for generic drugs. However, plans with additional gap coverage may charge a higher monthly premium. Check with the drug plan first to see if your drugs would be covered during the gap. Find health & drug plans. Pharmaceutical Assistance Programs. Some pharmaceutical companies offer help for people enrolled in Medicare Part D. Find out whether there’s a Pharmaceutical Assistance Program for the drugs you take. State Pharmaceutical Assistance Programs. Many states and the U.S. Virgin Islands offer help paying drug plan premiums and/or other drug costs. Find out if your state has a State Pharmaceutical Assistance Program. Apply for Extra Help. Medicare and Social Security have a program for people with limited income and resources that helps you pay for your prescription drugs. If you qualify, you could pay no more than $3.30 for each