With many Medicare plans dropping insulin coverage in 2024, it is crucial to choose the right plan before the end of open enrollment on December 7.
An informal survey by 65 Incorporated, a health consult in Wisconsin, revealed of 22 Medicare plans,10 are dropping at least one insulin from their formulary.
Experts urge insulin users to ensure their Medicare plan covers the medication in 2024. If it does, the $35 cap for a month’s supply for each insulin product applies.
The changes in insulin coverage may result from provisions of the Inflation Reduction Act passed by Congress in 2022. For instance, all insulin products covered by Part D plans will continue being capped at $35 next year.
Additionally, in 2024, cost-sharing will be eliminated for Medicare Part D plan buyers who reach "the catastrophic coverage level," which is $7,400 in out-of-pocket spending.
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Experts say insurance companies are adjusting to changes by choosing not to cover insulins with manufacturing costs or are facing production challenges.
Novo Nordisk has recently announced the discontinuation of Levemir in the U.S. market, with supply disruptions expected to start in mid-January. The Danish pharmaceutical company cited manufacturing constraints, reduced patient access, and available alternatives. This means Levemir users should look for an alternative covered by their insurance plan.
Patients on a Medicare plan that no longer covers insulin will have to pay hundreds of dollars out of pocket in 2024. They won’t be able to change the plan until next year.
Live-saving insulin in the U.S. is about 10 times more expensive than in the rest of the world, putting a financial strain on families and endangering lives.
A 2022 study found that 14.1% of American insulin users reached catastrophic spending — more than 40% of family income on insulin — over one year. Of those, nearly two-thirds were Medicare beneficiaries.
- Centers for Medicare & Medicaid Services. Frequently Asked Questions about Medicare Insulin Cost-Sharing Changes in the Prescription Drug Law.
- Medicare Resources. How the Inflation Reduction Act could affect your 2024 Medicare Part D prescription drug coverage.
- RAND Corporation. The Astronomical Price of Insulin Hurts American Families.
- Health Affairs. Catastrophic Spending On Insulin In The United States, 2017–18.