The unpredictable and sky-rocketing cost of insulin has driven far too many Medicare patients to ration their medicine or even go without. Heart attack, stroke, vision loss, kidney failure, and nerve damage are just a few of the devastating complications that can result. Especially at a time when diabetics are particularly vulnerable to the Coronavirus, this situation is deeply concerning.
Diabetes afflicts over a quarter of Medicare beneficiaries and drives billions in Medicare spending every
year. Unfortunately, insulin, a life-saving and life-enhancing drug that once sold for $
1 dollar, has nearly tripled in cost over the past ten years from approximately $100 to $300 per vial.
In 2017, President Trump challenged his administration to strengthen and modernize the Medicare program, and to lower punishingly high drug prices for our nation’s seniors by bringing free market principles to bear.
It’s
worked: are at one of their lowest levels in seven years, saving beneficiaries a total of $1.9 billion, and taxpayers $8.5 billion, since 2017. Now, we are applying the same approach to the costs seniors pay for the drugs themselves.
This year, President Trump
struck a deal –known as the Part D Senior Savings Model – with pharmaceutical manufacturers and plans that will provide many Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s prescription. We are encouraging beneficiaries to see if a participating plan that includes their insulin is right for them during Medicare Open Enrollment, which begins October 15.
This initiative could save the over 1.3 million seniors who rely on Medicare Part D plans and use insulin, an average of $446, or 66 percent, a year on their insulin costs. For those whose health, and even lives, depend on insulin, the savings will be nothing short of a godsend.
The Model fixes a
perverse incentive that was
introduced in Obamacare known as the “special rule.” [Section 3301]. Throughout the year, as Medicare beneficiaries fill more prescriptions, they will often notice different costs at the pharmacy counter as they move through the different “phases” of the Part D benefit. If a person has over $4,000 in drug costs for a year, they hit the coverage gap phase – often known as the “donut hole” – where they generally pay 25% of the cost of the drug, and manufacturers pay 70%.
