Inflation Reduction Act and Insulin
This law, which was passed in August, will cap all insulins in 2023 at $35 a month that is covered by your Part D or Medicare Advantage plan. The cap applies over all phases, including in the gap. It also applies to the plan’s preferred pharmacies and standard pharmacies. Some plans have already slated copays below $35 a month.
If you use a traditional insulin pump, it is durable medical equipment that falls under Medicare Part B. The insulin to supply the pump also falls under Part B. Medicare Part B will not be updated for insulin savings until July 1, 2023, and neither will supplement plans or Medigaps.
Drug plans had to submit their cost data and formularies, which determine whether a medication is covered and at what tier, to Medicare in April. Drug plans can only change their formularies during the year with Medicare approval. Because the law was passed after the plans’ submission deadline, Medicare may allow Special Enrollment Periods if coverage of the insulins drops due to the change in law and/or the plan finder reflects old information.
The law will be good in the long run, but there may be teething pain in the short run. If the cost of filling your insulin prescription proves different than expected in 2023 and is more than $35 a month, you may want to meet with a SHINE counselor during 2023.
