CMS to test model limiting out-of-pocket costs for insulin

Medicare Part D prescription drug plan beneficiaries could see lower out-of-pocket costs for insulin under a new model launched by the Centers for Medicare & Medicaid Services.

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The plan, dubbed the Part D Senior Savings Model, would lower out-of-pocket costs to a maximum of a $35 copay for a 30-day supply throughout the plan year. The agency estimates that beneficiaries enrolling in a plan that is participating in the model would save an average of $446 annually in out-of-pocket costs for insulin.

The maximum copay will apply to all phases of the Part D benefit, including the deductible, initial coverage, and coverage gap phases, according to a fact sheet issued March 11 by the agency. CMS will be proving additional risk corridor protections to Part D plan sponsors to encourage participation in the voluntary model.

The agency has released two requests for application to participate in the model, one for Part D sponsors and one for insulin manufacturers, both of which can be found on a CMS web page providing more details on the program.

The agency said in the fact sheet that, on or around March 20, 2020, it will announce the manufacturers that are participating in the model for the 2021 plan year.

gtwachtman@mdedge.com