Senior News

Insulin $35

More Americans with diabetes will get a break on their insulin costs in 2024 !

Medicare Beneficiaries will now pay no more than $35 a month for each of their insulin prescriptions, thanks to the Inflation Reduction Act, which Biden-Harris and Democratic lawmakers pushed through Congress in 2022.

Some 8.4 million Americans rely on insulin to survive, and as many as 1 in 4 patients have been unable to afford their medicine, leading them to ration doses – sometimes with fatal ramifications, according to the American Diabetes Association.

Because of the high prices that Big Pharma has been charging for life saving insulin medication,

Drug-makers have come under fire for years for steeply raising the price of insulin, which is relatively inexpensive to produce. The inflation-adjusted cost of the medication has increased 24% between 2017 and 2022, and spending on insulin has tripled in the past decade to $22.3 billion in 2022, according to the American Diabetes Association. The Biden-Harris administration increased pressure on insulin manufacturers to lower their prices, and through the now passed Inflation Reduction Act, affords most diabetes patients the $35 price cap.

New Drug Laws

Saving money with the prescription drug law

A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare. This law improves access to affordable treatments and strengthens the Medicare program. Here’s what the law means for you:

More vaccines covered

People with Medicare Part D drug coverage now pay nothing out-of-pocket for even more vaccines. Your Part D plan won’t charge you a copayment or apply a deductible for vaccines that the Advisory Committee on Immunization Practices recommends, including the vaccines for shingles, whooping cough, and more.

Lower costs for insulin

Part D insulin costs

Your Medicare drug plan can’t charge you more than $35 for a one-month supply of each Part D-covered insulin, and you don’t have to pay a deductible. You’ll pay $35 (or less) for a one-month supply of each Part D-covered insulin product, even if you get Extra Help to lower your prescription drug costs.

If you get a 3-month supply of insulin, your costs can’t be more than $105 ($35 for each month’s supply).

Part B insulin costs

If you use an insulin pump that’s covered under Part B’s durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month’s supply of Part B-covered insulin can’t be more than $35. The Part B deductible won’t apply. If you have Part B and Medicare Supplement Insurance (

Medigap

) that pays your Part B coinsurance, your plan should cover the $35 (or less) cost for insulin. 

If you get a 3-month supply of insulin, you’ll generally pay no more than $105, because your costs can’t be more than $35 for each month’s supply of each covered insulin. 

Get more information about this new insulin benefit. 

Learn more about insulin costs.

Lower out-of-pocket drug costs

    • You might pay a lower coinsurance amount for certain drugs and biologicals covered by Part B, if their prices have increased higher than the rate of inflation. The specific drugs and potential savings change every quarter.
    • If you have drug costs high enough to reach the catastrophic coverage phase in your Medicare drug coverage, you won’t have to pay a copayment or coinsurance, starting in 2024.
    • Extra Help affording prescription drug coverage (the Part D Low-Income Subsidy (LIS) program) will expand to cover more drug costs for people with limited resources who earn less than 150% of the federal poverty level, starting in 2024. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
    • Your yearly Part D

out-of-pocket costs

  • will be capped at $2,000, starting in 2025. You’ll also have the option to pay out-of-pocket costs in monthly amounts over the plan year, instead of when they happen.
  • If the price of a drug covered by Part B (Medical Insurance) increased faster than the rate of inflation, you might pay less than 20% coinsurance for that drug. The specific drugs that are impacted and the potential savings may change every quarter. Get more information about Part B-covered drugs.

Medicare will negotiate to get you lower drug prices

For the first time, Medicare will be able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that don’t have competition.

  • The first 10 drugs selected for negotiation are:
    • Eliquis
    • Jardiance
    • Xarelto
    • Januvia
    • Farxiga
    • Entresto
    • Enbrel
    • Imbruvica
    • Stelara
    • Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill
  • Negotiated prices for these first 10 drugs will be effective in 2026.
  • In the future, Medicare will select and negotiate costs for:
    • 15 Part D drugs in 2025 (effective in 2027).
    • 15 Part B and Part D drugs in 2026 (effective in 2028).
    • 20 Part B and Part D drugs in 2027 (effective in 2029).
    • 20 Part B and Part D drugs in 2028 and every year after.
  • Manufacturers that don’t follow the negotiation requirements will have to pay a tax, and will have to pay penalties if they don’t fulfill other manufacturer requirements.