If you have Medicare and need insulin to manage your diabetes, there's good news. The Centers for Medicare and Medicaid Services (CMS) implemented a maximum limit of $35 per month for insulin prescriptions under Medicare Part D. This means that regardless of the type or brand of insulin you need, you will only have to pay a maximum of $35 for a 30-day supply.
The $35 cap also applies if you get a two- or three-month supply of insulin. For example, if you receive a two-month supply, the maximum cost will be $70. If you receive a three-month supply, the most you will pay is $105.
To take advantage of this new cap on insulin costs, follow these steps:
- Contact your Medicare Part D prescription drug plan to ensure they apply the $35 monthly cap to your insulin prescriptions.
- Consult with your healthcare provider to discuss your insulin needs and any necessary adjustments to your prescription.
- Review your coverage during Medicare's Annual Enrollment Period (AEP) from October 15 to December 7 to explore better coverage options and lower costs for insulin and other healthcare needs.
Affordable access to vital medications is crucial for managing chronic conditions like diabetes. The $35 cap on monthly insulin costs is a significant step towards ensuring affordable care.
If you have questions or concerns, contact your Medicare Part D plan provider or reach out to Medicare directly at 1-800-MEDICARE (1-800-633-4227).
At Tanner, we are committed to supporting your healthcare journey towards a healthier and more affordable future.
About Medicare Part D
Medicare Part D is a prescription drug coverage program that helps with medication costs. It is offered through private insurance companies approved by Medicare. Enrollment in Part D is optional but generally advised.
Note for Medicare Part B beneficiaries
If you use a traditional insulin pump covered under Medicare Part B's durable medical equipment (DME) benefit, the $35 cap on insulin costs starts on July 1. The Part B deductible will not apply, and if you have Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, it should cover the $35 (or less) cost for insulin.