Today, CMSGov launched a groundbreaking model to lower out-of-pocket expenses for insulin. It allows Medicare Part D prescription drug plans to offer beneficiaries plan choices that provide a broad range of insulins at a $35 copay. Read more:
Today, under President Trump’s leadership, the Centers for Medicare & Medicaid Services 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.
This Model will test a plan design for enhanced Part D plans that ensures that beneficiaries in participating plans will have predictable copays for a broad set of formulary insulins, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins, marketed by participating manufacturers from the beginning of the plan year and through the coverage gap phase.
The model is targeted to enhanced Part D plans that offer more generous prescription drug coverage than Part D basic benefit designs. These enhanced plans can reduce cost sharing beyond basic Part D plan types, such as fixed dollar copays instead of setting out-of-pocket costs to be a percentage of a drug’s price . In exchange for these additional benefits, enhanced plans have slightly higher premiums, which are paid for by beneficiaries or through other means, such as a Medicare Advantage plan.
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