Part D Senior Savings Model - Lower Out of Pocket Expenses for Insulin

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CMS

Launches Groundbreaking Model to Lower Out of Pocket Expenses for Insulin

The Part D Senior Savings Model allows Medicare Part D prescription

drug plans to offer beneficiaries plan choices that provide a broad range of

insulins at a $35 copay 

Today, under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) announced the Part D Senior Savings Model, a voluntary model that enables participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs for insulin to a maximum $35 copay per thirty-day supply throughout the benefit year. Beneficiaries who take insulin and enroll in a plan participating in the model should save an average of $446 in annual out-of-pocket costs for insulin, or over 66 percent, relative to their average cost-sharing for insulin today. The Model’s initial projections assume it generates over $250 million in savings over five years for the federal government, largely due to pharmaceutical manufacturers paying additional coverage gap discounts. As beneficiaries have more consistent, predictable access to the prescription drugs they need, the model projects that health will improve and total cost of care will decline for our nation’s seniors. This Model follows on the Trump Administration’s previously announced 13.5 percent decline in the average monthly basic Part D premium since 2017 to the lowest level in 7 years.

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https://www.cms.gov/newsroom/fact-sheets/part-d-senior-savings-model