Older adults living with diabetes and enrolled in Medicare will see drastically reduced prices on insulin this coming year, but beneficiaries may have trouble viewing these savings during enrollment.
Congress passed the Inflation Reduction Act in August, which will lower major Medicare costs in 2023. Part of the act states that no Medicare user will pay more than $35 a month for insulin.
However, the law change came too late for Plan Finder to include the price cap on insulin. Plan Finder is an online tool that helps beneficiaries search drug and medical plans for the best deal.
Currently, beneficiaries who check Plan Finder for insulin will see costs of several thousand per year, instead of the maximum $420 mandated by the Inflation Reduction Act.
“An inaccurate price could also distort the costs of other drugs, which depend on what coverage phase patients reach,” Susan Jaffe wrote in Kaiser Health News. “For example, once both the plan and the patient spend a total of $4,660 for all drugs next year, the member pays no more than 25% of the cost for noninsulin drugs.”
To make up for this confusion, Medicare will allow beneficiaries to make one change after Dec. 8 using a special enrollment procedure, during which users can adjust their plan to account for the insulin cap that was not included the first time they enrolled.
Currently, users who search for the $35 insulin cap on Plan Finder will see a pop-up that points them to the Medicare help line – 800-633-4227 – or a counselor with the State Health Insurance Assistance Program, which works on a state-by-state basis to offer insurance counseling for Medicare-eligible seniors.
The pop-up doesn’t mention the option of using special enrollment to add the insulin cap after the Dec. 7 deadline. The change in insulin prices under Medicare will go into effect on Jan. 1 for those who use injectables and July 1 for those who use pumps.