Move to Help Medicare Beneficiaries Afford Insulin Does Not Go Far Enough

This week, the Trump administration announced a new two-year demonstration program that will reduce insulin costs for some people with Medicare drug coverage. The lower costs will no doubt be welcomed by the 1.3 million enrollees who stand to benefit, and we applaud this help. However, we are disappointed that this initiative will not offer relief to all who need it or address larger issues around prescription drug access and affordability.

Under the new program, the Part D Senior Savings Model, beginning in 2021 people with Medicare will be able to purchase a Part D plan that caps monthly insulin cost-sharing at $35. The Centers for Medicare & Medicaid Services (CMS) estimates this will save affected enrollees $446 per year, on average, while also providing them with much-needed certainty regarding their monthly insulin costs. While participation is voluntary for insurers and drug makers, CMS expects plans to be available in every state.

Efforts to improve access to insulin are long overdue. When diabetics are unable to afford their needed medication, they suffer serious health complications, including blindness, amputations, and even death. Unfortunately, insulin costs have skyrocketed in recent years, and a lack of affordability is an increasing problem.

These facts make steps to reduce insulin costs at the pharmacy counter very welcome. However, the new program does not do enough to rein in costs. Not only will some Medicare beneficiaries be left out in the cold, the model does nothing to curtail costs for other drugs that are just as vital to consumer health, such as heart medications, cancer drugs, or treatments for neurological conditions or serious autoimmune disorders. It also fails to cap overall drug costs for people with Medicare to ensure they can afford all of their medications throughout the year.

At Medicare Rights, we continue to support strong action on multiple fronts to bring down drug costs. This includes authorizing Medicare to negotiate drug prices, capping out-of-pocket expenses for both drugs and other Medicare expenditures, and reforming the Part D appeals process to make it easier for people to obtain needed prescriptions. To that end, we continue to support comprehensive legislation like the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) which would meaningfully address prescription drug affordability and strengthen the Medicare program.

Read more about the Part D Senior Savings Model.

Read more about issues with insulin affordability.

Read more about other efforts to reduce drug costs.