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CT Medicare enrollees could see savings under insulin price cap

Man Checking His Blood Glucose with a Home Glucometer Test Kit to Manage Diabetes
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Checking blood glucose level is part of managing diabetes.

Seniors enrolled in Medicare will start seeing the monthly price for insulin capped at $35 as parts of a federal law go into effect this year. Under the new health provision, a federal agency estimates that thousands in Connecticut could see lower out-of-pocket costs for the lifesaving drug.

U.S. Secretary of Health and Human Services Xavier Becerra released a report on Tuesday about the anticipated savings for insulin users on Medicare by state because of legislation passed by Congress last year called the Inflation Reduction Act.

An agency within HHS broke down those projections with state-by-state data from 2020. It estimated how much Medicare enrollees would have saved in annual out-of-pocket costs that year if the price for a 30-day supply of insulin did not exceed $35.

The insulin cap is limited to those on Medicare since broader efforts in Congress to rein in costs for those with private insurance were blocked. The provision began on Jan. 1 for those enrolled in Medicare Part D, which covers injectable and inhaled insulin as well as disposable patch pumps. On July 1, those same savings will take effect for those in Medicare Part B, which includes non-disposable pumps when deemed medically necessary.

“No one should have to skip or ration their insulin because they can’t afford it,” Becerra said Tuesday. “These are the kinds of savings that will give people a little breathing room. People don’t have to make gut-wrenching decisions to forgo medicine to get food on the table.”

The report found that 1.5 million Americans who are on Medicare Part B and D would have saved an average of about $500 in 2020 if the insulin cost-sharing limit were in place. In Connecticut specifically, seniors would have saved slightly above the average out-of-pocket savings for Medicare beneficiaries across the U.S.

About 11,444 Medicare enrollees in Connecticut would have received out-of-pocket savings in 2020 under the Inflation Reduction Act. Those beneficiaries would have saved an estimated total of about $6.7 million with an average annual savings of $590 per enrollee.

Many Americans who require the use of insulin have been paying much steeper monthly prices. Nearly 30% of those on Medicare have diabetes, compared with the general population at 11%.

The HHS study found that in 2019, 37% of insulin fills for Medicare recipients were more than $35. That same year, the average out-of-pocket cost for people either on Medicare or private insurance was about $63 a month.

Connecticut has its own law that caps out-of-pocket prices for insulin at $25 per month. It applies to some residents who have private insurance, like those enrolled through the state exchange, but does not include those who have plans that are federally regulated.

HHS officials said Tuesday that more individuals could benefit in 2023 due to an uptick in the number of people becoming eligible for Medicare and needing insulin as well as those who are no longer rationing their insulin supply and taking it monthly because it is now more affordable.

“We will have more Medicare beneficiaries than we did in 2020, which suggests that we may have more beneficiaries who unfortunately may have diabetes,” said Nancy DeLew, associate deputy assistant secretary for a policy department within HHS. She added that they “don’t have an estimate of who might take insulin in 2023.”

Meena Seshamani, a deputy administrator at the Centers for Medicare & Medicaid Services, said the “overwhelming majority of plans” were ready to enact the insulin cap on Jan. 1. For those that have not fully implemented it, the plan has 30 days to reimburse enrollees if they paid more than $35 a month. They have until March 31 to get their system in line with the cost-sharing limit.

Democrats’ wide-ranging Inflation Reduction Act includes a number of other health care benefits along with priorities on climate change and a tax overhaul. But many of the health measures in the law will take several years to roll out, including Medicare’s ability to negotiate prescription drug prices for the first time in its history.

That provision will initially apply to 10 drugs starting in 2026, and then the number will increase each year through 2029. Becerra also noted on Tuesday that HHS will start this year selecting the initial prescription drugs that can be negotiated to get lower costs.

Aside from the insulin measure, seniors across the country will see more relief this year. They can get additional adult vaccines covered by Medicare Part D — like the immunization for shingles — at no cost. The law also requires drug manufacturers to pay rebates if their prices in Medicare increase beyond the rate of inflation.

Lisa Hagen is the federal policy reporter in a collaboration between Connecticut Public and The Connecticut Mirror. Hagen is based in Washington, D.C., and produces stories that examine the impact of federal policy on Connecticut.

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