CMS Announces Lower Costs for Insulin in 2021

Insulin is a necessary expenditure each month for millions of Americans living with diabetes. As with any regular medical cost, however, the amount we pay for insulin adds up throughout the year. The Centers for Medicare & Medicaid Services (CMS) announced that more than 1,750 Medicare Part D and Medicare Advantage plans will be meeting a standardized payment in 2021.

The Announcement

On May 26, 2020, CMS announced that participating drug plans (both Part D plans and Part C plans with drug coverage) would be limiting the out-of-pocket cost for a month’s supply of insulin at a maximum of $35 for the copay. These changes will come into effect for the 2021 Medicare plan year. With around a third of all Medicare beneficiaries living with diabetes, this news will bring emotional and financial relief.

This announcement should allow payments to be more consistent across the different phases of coverage in a Part D plan — from your initial deductible phase through the coverage gap and into catastrophic coverage. Previously, the costs of insulin could differ from month to month depending on which phase of coverage the beneficiary is in.

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