Posted on Diabetes

$35 max copays on insulin for Medicare beneficiaries in 2021

Brightfield light micrograph of pyramidal neurons (nerve cells) in the human cerebral cortex. Cortical pyramidal neurons (black; Cajal Golgi stain) are pyramidal shaped nerve cells with a primary, elongated dendritic extension (apical dendrite). The cerebral cortex is a layer of nervous tissue that is outermost to the cerebrum of the mammalian brain. It is called the grey area (grey matter) of the brain due to nerve fibres that lack insulation (myelin sheath). The cerebral cortex covers the cerebrum and cerebellum. It consists of up to six horizontal layers. Layer 3, the external pyramidal layer, contains the pyramidal nerve cells. The cerebral cortex plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. Magnification: x40 when shortest axis printed at 25 millimetres.


There is a light at the end of the tunnel for seniors on Medicare who use insulin to treat diabetes.  Did you know that over 3 million Medicare beneficiaries use at least one or more forms of insulin? The American Diabetes Association (ADA) has stated that senior citizens with diabetes spend twice as much on their healthcare costs than a senior without the disease. This puts the annual spending on healthcare for diabetic Medicare beneficiaries around $12,000 a year.

In 1996, the price for a vial of insulin was $21 and increased to $35 in 2001. In 2020, one vial of insulin can cost up to $250, and some people need more than one vial per month. You can see how that is a significant increase and is frightening to diabetics. There have been proposals for years to lower the price of insulin. The Part D Senior Savings Model is bringing these proposals to life with the new $35 max copays on insulin for Medicare beneficiaries in 2021.

Part D Senior Savings Model

President Donald Trump had emphasized lowering the cost of overpriced prescription drugs, and on March 11, 2020, he introduced us to the Part D Senior Savings Model. The high out-of-pocket costs for insulin that senior citizens pay, can fluctuate throughout the year, making it difficult to budget on a fixed income. It is not unheard of for a senior to ration their insulin or flat out not receive it due to the detrimental cost of insulin.

The Model will create stable and predictable costs for insulin users throughout the year. CMS is encouraging Part D sponsors to offer fixed copays for senior citizens, rather than a coinsurance such as the 25 percent you would typically pay in the coverage gap. With that said, the participating drug plans will gain Medicare beneficiaries access to a wide range of insulins with a maximum copay of $35 for a month’s supply of insulin.

Part D in 2021

CMS announced that there would be over 1,750 standalone Medicare Part D and Advantage plans that have applied to offer lower insulin costs with the new Model. In 2021, the participating drug plans will include at least one vial and pen of insulin for each of the four types of diabetes (rapid-acting, short-acting, intermediate-acting, and long-acting).

Some Part D plans can leave a Medicare beneficiary spending over $1,140 a year on insulin. When the Model is in place, the average annual cost for insulin for beneficiaries will be $229. Drug manufacturers are also contributing to the Model by agreeing to include all drugs that are or contain insulin that meet the Part D criteria. You will have access to the various insulins through preferred and nonpreferred pharmacies. You will have no insulin boundaries in 2021!

Enrolling in Part D

CMS is predicted to release carrier premiums and additional information for the Part D Savings Model for 2021 by September 2020. Around this time, you will also be receiving your current plan’s Annual Notice of Change. When you receive this notice, you will want to review it thoroughly. When enrolling in your new Part D or Advantage plan, you will want to compare your current and new plan to ensure you are making the right decision in changing.

The Annual Election Period is your time to enroll, change, or drop your Medicare Advantage or Part D plan. The AEP will begin on October 15, 2020 and will end on December 07, 2020. With that said, your new Part D or Advantage plan will become effective on January 01, 2021.

CMS will be upgrading and improving their Medicare Plan Finder tool on Medicare.gov. This tool will help beneficiaries find and compare participating plans in the new Part D Model.  These Part D plan options will be available in all 50 states across the nation, as well as Puerto Rico and the District of Columbia.

The cost of insulin has been protested for being financially unreasonable for years. Diabetes is an ongoing disease that is going to continue in our society until the end of time. Luckily, the year 2021 will be a year of savings for diabetic senior citizens. Having a $35 max copay on insulin for Medicare beneficiaries will help seniors’ budget and receive the insulin they need.