ATLANTA, Ga. -- A lifesaving new law caps insulin costs for people with Medicare, saving people with diabetes hundreds of dollars per year. Now, Georgians in Medicare prescription drug plans will have peace of mind knowing that they will no longer have to pay more than $35 a month for the insulin they need to stay healthy.
[RELATED: What You Need to Know About the Medicare Insulin Cost Cap]
Skyrocketing insulin prices and associated out-of-pocket costs for people with Medicare have forced millions to choose between paying for medicine, groceries, and other necessities. Research shows more than one in 10 older adults with diabetes skip, delay, or use less insulin than needed to save money, which can lead to serious health complications and even death.
Before the new law took effect, people in Medicare prescription drug plans with diabetes paid an average of $54 for each insulin prescription and $700 a year out of pocket. The new law is an essential first step to making insulin and associated out-of-pocket costs more affordable.
Get the facts:
• Starting January 1, 2023, Medicare prescription drug plans must limit copayments to $35 per month for the insulins they cover. A similar copay cap will take effect under Medicare Part B for insulin administered through insulin pumps starting July 1, 2023.
• The law creating the $35 monthly copay cap was passed after drug plans had already set their premiums and copays for 2023, so the Medicare Plan Finder website may not reflect the new cap.
• If you find out that your plan does cover your insulin and you paid more than $35 per month in early 2023, your plan has to reimburse you within 30 calendar days for any amount you paid above the $35 limit. Contact your plan to find out how to get reimbursed.
• Not every prescription drug plan covers every type of insulin. Individuals must check to make sure their plan covers the insulin their doctor prescribes. If not, they should talk to their provider to suggest an alternative.
• Medicare created a Special Enrollment Period that gives enrollees who take insulin until December 31, 2023, to review their prescription drug plan options to see if they can save money by changing plans.
• To change plans, call the Medicare hotline at 1-800-MEDICARE (1-800-633-4227). You can also get personalized assistance through your local State Health Insurance Program (SHIP) (1-877-839-2675).
For more information, visit www.aarp.org/insulin.
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