1. How Much Does A Month Of Insulin Cost
2. Is Insulin Now 35 Dollars
3. Insulin Copay
4. Is Insulin 35 Dollars Now

Regular insulin. Regular insulin is also referred to as “short-acting” insulin and is taken several times per day. It used to be the only option for managing your blood sugar around meals, but compared to today’s “rapid” and “fast” acting insulins, Regular insulin is very slow-working because it stays in your system for a long time, up to 8 hours, and peaks nearly 4 hours after. If you choose a Part D plan with this benefit you will pay $35 per each 30-day supply of a covered insulin prescription until you reach the catastrophic coverage phase, during which you will pay 5% co-insurance. Insulins covered by participating plans will not be subject to the deductible or donut hole phases of Part D coverage. Generally, Medicare Part D plan coverage has different phases, including a deductible, the donut hole and catastrophic coverage. Under this new option, Medicare enrollees with diabetes will pay $35 per each 30-day supply of a covered insulin prescription until they reach the catastrophic coverage phase, during which they will pay 5% co-insurance.

• About 30% of 2021 Medicare prescription drug plans offer insulin at a maximum co-pay of $35 or less per month throughout the initial deductible, initial coverage, and the Donut Hole. But the $35 coverage depends on the plan and the specific type of insulin.
• Insurers will limit insulin costs to $35 copay for Medicare Part D plans next year More than 1,750 Medicare part D plans and Medicare Advantage plans will limit out-of-pocket insulin costs to a $35.

By Karena Yan

The program is predicted to save older Americans hundreds of dollars per year

The Centers for Medicare and Medicaid Services (CMS) has announced a new pilot program that will cap the monthly cost of insulin at $35 for Americans on Medicare, a federal health insurance program for people 65 years or older. The program, which will go in to effect in 2021, is predicted to save older Americans an average of $446 a year.

All three insulin manufacturers – Sanofi, Eli Lilly, and Novo Nordisk – have agreed to participate in the pilot program. During a time of much public outrage over insulin prices, which doubled between 2012 and 2016 and continue to rise today, drug companies have been scrambling under the pressure. In addition to offering insulin discount cards and other forms of copay assistance, insulin manufacturers are hoping to use this program to make insulin more affordable for Medicare recipients, more than one-third of whom say cost has impacted their purchase of insulin.

However, because the program only applies to Medicare recipients, some critics deem the insulin proposal as too little, too late.

“It still leaves huge numbers of people with diabetes who rely on insulin in the same place they were before — rationing and suffering,” said Elizabeth Pfiester, the founder and executive director of patient advocacy group T1International. “Many of the deaths we are seeing from rationing are young people without insurance, so we need federal action that provides immediate relief and long-term solutions for everyone.”

Moreover, while over 3.3 million Medicare recipients use at least one form of insulin, the pilot program only applies to “enhanced” Medicare drug plans, which have more extensive drug coverage but have more expensive premiums. Thus, even among Medicare beneficiaries, not everyone can benefit from the new policy.

The program it is predicted to save the government $250 million over five years in direct health plan spending. However, affordable access to insulin will likely lead to fewer hospitalizations and diabetes complications, meaning federal savings are likely to surpass that projection.

How Much Does A Month Of Insulin Cost

This pilot program is a nod in the right direction, and three other states – Colorado, New Mexico, and Virginia – have already mandated a cap on insulin prices. However, these policies still do not solve the larger structural issues surrounding insulin affordability. The program has no impact on younger people on high-deductible health plans, who pay full price for insulin until they meet their deductible, or individuals with no insurance at all.

Update 9/10/20:Lilly announced that the $35 copay card has been added to their suite of insulin affordability solutions, and will remain accessible indefinitely.

People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool, GetInsulin.org.

On April 7, 2020, Eli Lilly announced the introduction of the Lilly Insulin Value Program, allowing people without health insurance and people with commercial health insurance in the United States to fill their monthly prescription of Lilly insulin for $35 per month through a new copay card.

“Too many people in the U.S. have lost their jobs because of the COVID-19 crisis, and we want to make sure no one goes without their Lilly insulin,” said Mike Mason, president, Lilly Diabetes. “We’ve been providing affordability solutions for a long time, but more is needed to help people during this unprecedented period. People with commercial insurance, as well as those without insurance at all, are eligible, and the process is quick and simple. We want people who need help to call us.”

Included in the press release was a quote from CEOs Aaron Kowalski and Thom Scher on behalf of the JDRF – Beyond Type 1 Alliance stating, “It’s critical that people with diabetes can reliably access insulin at a low, consistent out-of-pocket cost. Enabling a $35 per month insulin copay regardless of employment status will help many Americans in this difficult time.”

Andy Vicari, US Insulin Brand Leader for Lilly Diabetes, spoke to Beyond Type 1 and answered some of the most pressing questions about this new program, including the process for obtaining the savings card, how the program will work with insurance, how long it will last, and why it was introduced at this time.

Who is eligible for this program?

This program is available to patients in the US with commercial insurance, including those with high deductible plans. Notably, this program is also available to US patients without commercial insurance, a subset who have been excluded from using copayment cards in the past.

The Lilly Insulin Value Program is NOT available to patients with any government insurance including Medicaid or Medicare. Patients who are not eligible are still encouraged to call the Lilly Diabetes Solutions Center for advice on other cost-saving measures. However, last month the Centers for Medicare & Medicaid Services (CMS) launched a new plan for some Medicare Part D participants to pay a maximum $35 copay for their monthly supply of insulin.

A note from Beyond Type 1:if you do not qualify or do not take Lilly Insulin, explore options here.

How does it work?

Patients with an active prescription for a Lilly insulin should call the Lilly Diabetes Solution Center at 833-808-1234. From there, patients can choose whether to receive the savings card via email (expected within 24 hours of placing a call) or in the mail. If you are filling prescriptions for more than one Lilly insulin, (for example Humalog and Basaglar) you will have a separate $35 monthly copay for each product. If you have an active copay card with Lilly, it will automatically be updated to the new $35 price point. The card will be good for the remainder of the year until January 2021, when it will need to be renewed.

Which insulins are covered and how much can you get?

Most Lilly insulins, including Humalog formulations and Basaglar, in either vials or pens, are covered by this new program. Note: Cartridges are not covered.

When asked how much insulin a patient could fill in a month, Vicari told Beyond Type 1 that although they monitor quantities in the background to prevent abuse of the system, “There’s effectively no cap… Patients will be able to get their Lilly insulin for $35 a month, regardless of the dosage.”

***

Update 4/9: After reports of a $7,500 limit, we reached out for clarification.

Wade Neucks, Director of the Patient Affordability Solutions Team at Lilly Diabetes told Beyond Type 1 “The $7,500 is an annual limit, not lifetime. The limit is based on the amount Lilly covers at the pharmacy and not the list price. In the very rare event that someone meets that limit, they should call the Lilly Diabetes Solution Center back and ask for help. The Solution Center can work with your pharmacy to see if an adjustment to your solution is necessary.”

***

Vicari also said that those with deductibles, including people with high deductible health plans (HDHPs), should see these $35 copays count towards their deductible.

“If they are covered by Lilly insulin today on their insurance plan, and they use this card, it will count towards their deductible… barring some strange benefit designs… In general, we have seen all insurance [companies] are warm to leveraging these [programs] for their individual customers.”

How long will the program last?

Although the press release cites the new $35 copay program as a direct response to the COVID-19 crises in America, it may be here to stay, and will at least last until the end of 2020.

Vicari told Beyond Type 1 “We’re always looking at all of our programs just based on the changing landscape in the healthcare system, but we have no plans to stop this program post-Coronavirus, whenever that is. It’s just something we felt was the right decision — prompted certainly by what’s happening today — but we don’t have plans in place to stop the program. We always look at all of our programs on an annual basis to make sure they’re optimized for the breadth that we need to cover: as many people as we can that are touched by Lilly insulins.”

Why now?

When asked about the timing of this new $35 copay program, Vicari framed it as a natural progression of increased affordability options Lilly has offered recently, citing the company’s partnership with Blink Health in 2016, the launch of the Lilly Diabetes Solutions Center in 2018, and the introduction of a 50% generic version of Humalog (insulin lispro) in 2019.

“The short answer, it was prompted by the COVID-19 pandemic and is what we needed to do. Mac os catalina macbook air 2013. At the same time this is not a new behavior for us, in that we’re constantly looking for new things that we can be doing and should be doing to impact the market, certainly people that are taking our insulins… In a time like this you have to pull out all the stops to get whatever you can done.”

Is Insulin Now 35 Dollars

Beyond Type 1 is hopeful that this move by Lilly Diabetes puts pressure on other insulin manufacturers to follow suit and drastically expand insulin assistance programs, for all insulins and all patients, especially those who are uninsured or enrolled in high deductible health plans.

Insulin Copay

For more resources on what to do if you find yourself suddenly jobless or without health insurance, click here.

Is Insulin 35 Dollars Now