Health Law & Business News

Insurers Embrace Medicare Plan to Cap Insulin Costs (1)

May 26, 2020, 4:31 PMUpdated: May 26, 2020, 9:53 PM

Over 1,700 Medicare prescription drugs and managed care plans have applied to participate in a Trump administration savings model that will mean seniors won’t have to pay more than $35 per month for insulin, the CMS announced Tuesday.

Nearly half of all eligible Medicare Part D and Medicare Advantage plans will offer this, President Donald Trump said Tuesday afternoon in the White House Rose Garden. Some plans may even choose to offer insulin at no cost, he added.

The Rose Garden event occurred as the president and his advisers sought to shore up his support among seniors. Trump’s internal polling has shown that his support with voters over 65 is declining during the Covid-19 pandemic, the New York Times reported.

Scheduled to attend the White House were representatives of Eli Lilly, Novo Nordisk, Sanofi, the Pharmaceutical Research and Manufacturers of America, UnitedHeathcare, Cigna, Express Scripts, Humana, Blue Cross Blue Shield Association, America’s Health Insurance Plans, American Diabetes Association, Alliance of Community Health Plans, among others.

If the model is successful, the administration will consider expanding it to other “high-cost drugs,” Centers for Medicare & Medicaid Services Administrator Seema Verma said in a call with reporters. The model is projected to save the federal government $250 million over five years and save beneficiaries an average of $446 per year, the agency said.

The model is aimed at providing predictability for seniors so they can budget for their drug costs and are able to afford their medicine. One out of every three Medicare beneficiaries has diabetes.

The CMS has expansive authority to create and test health-care payment systems without congressional approval.

The model will take effect Jan. 1, 2021. Plans will be in all 50 states, the District of Columbia, and Puerto Rico, Verma said.

Premiums increases are expected to go up $1 to $2 per month for enhanced Part D plans due to this model, Verma said.

All three major insulin manufacturers—Eli Lilly, Novo Nordisk, and Sanofi—previously committed to participating in the model.

Many of the Medicare prescription drug benefit provisions “just don’t work anymore,” Verma said.

(Updates with details of Rose Garden event.)

To contact the reporter on this story: Shira Stein in Washington at sstein@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.com; Brent Bierman at bbierman@bloomberglaw.com

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