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  • Salisa Westrick

Good news for Part D patients who use insulin

Beginning in 2021, as part of CMS’s, “Part D Senior Savings Model” Part D drug plans with enhanced alternative features, MA plans that include drug coverage, and Special Needs Plans may offer different types of insulin at a maximum co-payment of $35.00 per month.

This savings model will allow Medicare beneficiaries to choose a plan that provides access to a broad set of insulins at a maximum $35 copay for a month’s supply.


The model does not require all Medicare drug plans to offer this “supplemental coverage” of insulin and a Medicare drug plan that includes this fixed $35 (or less) insulin coverage is not required to offer the coverage for all types or brands of insulin. “Part D sponsors have the flexibility to offer a lower cost share for different types (e.g., rapid-acting, short-acting, intermediate-acting, and long-acting) and/or forms (e.g., pen, vial) of Model insulins that it is offering under the Model."


It is important to note that this offering is not available to those persons who are on Extra Help, as they are already receiving cost sharing assistance.


Our collaborator, Ms. Dawn Glascock, an Alabama State Health Insurance and Assistance Program (SHIP) counselor has compiled the list of the 10 plans that offer this fixed $35 (or less) insulin coverage. As always, we advise that patients should conduct a full prescription drug comparison before enrolling in any plan. AL SHIP will be happy to provide an unbiased consultation. Contact your local SHIP by calling 1-800-Age-Line.


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