Health Policy Lowers Insulin For Seniors & Lowers Covered California Cost

Health Policy Lowers Insulin For Seniors & Lowers Covered California Cost

Seniors who use insulin can look forward to reduction in their monthly insulin cost sharing cap to $35 a month. The recently passed Inflation Reduction Act contains a $35 copay cap that has a phase-in start date of Jan. 1 for people who use injectable insulin and on July 1 for patients who use an insulin pump. Unfortunately, not all insulins will be covered, and insurance companies can still restrict insulin brands through their formulary choices.

 

Medicare recipients also are provided free vaccinations recommended by the federal Advisory Committee on Immunization Practices and starting in 2025 the annual out-of-pocket drug cost limit, or the donut hole, will be capped at $2,000. The bill also contains a long-sought provision to allow Medicare to lower the cost of prescription drugs using their buying power to directly negotiate pricing with pharmaceutical companies. That could lead to even lower insulin prices when in 2026, the insulin cap would be $35 or 25% of the negotiated price if that is lower.

 

Attempts to lower insulin cost outside of Medicare were blocked on the Federal level, but eight states have placed caps on insulin costs which range for $25 to $100 for a 30-day supply and there are movements to pass a cap in other states. California is also looking for a unique way to lower insulin cost through the disruption of the market by directly making their own insulin. State lawmakers have approved $100 million to build a facility and to develop a low-cost insulin. The state plans on partnering with Civica Rx, a nonprofit generic drug company to sell generic versions of insulin to consumers at no more than $30 per vial and no more than $55 for a box of five pen cartridges. Their generic insulin is projected to be available in 2024.

 

Many diabetes advocacy groups continue to lobby for lower insulin costs for all people with diabetes and if you need help paying for insulin, the American Diabetes Association has created a resource page designed to help people receive discounts on insulin, sensors and pump supplies.

 

The same Inflation Reduction Act also contains good news for people younger than Medicare age. The Act extends the enhanced premium subsidies to buy insurance through the Affordable Care Act marketplaces which includes Covered California plans.