House caps insulin costs at $35 per month for Medicare beneficiaries
Insulin prices in the United States have risen dramatically over the past decade. This has hit Medicare Part D enrollees hard, with insulin prices rising about 10% per year under Medicare pricing.
Recently, the US Congress sought to change that, lowering prices for US patients. The Affordable Insulin Act Now (HR 6833, which the U.S. House of Representatives passed in March 2022, is now pending action in the U.S. Senate (S. 3700). The law aims to reduce the cost of insulin for diets. private health insurance as well as Medicare Part D plans.
The bill aims to reduce the cost of insulin products and would come into force on January 1, 2023. Co-payments for insulin products could not exceed $35 for a 30-day supply, or 25% of the cost of an insulin plan, as applicable. is less. Also, a person would not have to pay a higher amount to cover any unpaid insurance deductible. However, co-payments would count towards both a person’s deductible and their total maximum outgoings.
Not all insulins would be covered by law. However, at least one type of insulin per dosage form (including vials, pump products, and inhalers) would be required to meet the standards of the law. In addition, the law would require that at least one insulin be available for each duration of action. This includes at least one of each of the following:
However, there are exceptions to the law. For example, the law would not require insurance plans to provide low-cost insulin prescribed by out-of-network providers. Patients who go to an out-of-network provider for their insulin may be required to pay higher costs.
It is unclear whether the US Senate will pass the Affordable Insulin Now Act. As of June 2022, the bill has been before the Senate Finance Committee, where it is pending action. If the bill is introduced in the full US Senate and passed, it will be sent to President Biden and would then become law upon signing.
Even if the bill does not pass the US Senate, some seniors may still benefit from the influence of the bill. Currently, the Centers for Medicare and Medicaid Services (CMS) is testing a pilot program under the Medicare Part D prescription drug benefit. In this program, the cost of insulin is capped at $35 per month for participating plans. CMS estimates that seniors who are enrolled in a participating plan and taking insulin have an average savings of $446, or about 66% of their previous insulin costs. Medicare beneficiaries can enroll in eligible plans that meet their needs through Hello Health Where Health insurance plan search website.
However, as this is a pilot program, it is not permanent and ready to expire at the end of 2025. After that date, it is unclear what will happen to the program if the Affordable Insulin Now Act is not signed into law.
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