Medicare diabetics save on insulin; help on the horizon for others

As many as one in four of the current 8 million diabetics have skipped or shorted insulin doses due to the high cost. But 2023’s new market initiatives and legislative changes could make these lifesaving drugs more accessible to those in need, particularly those with Medicare. Sadly, some of these initiatives miss the mark. Here are some ways to lower the cost—in some cases, to less than $30.

Inflation Reduction Act

Over half of insulin users are on Medicare, and they will benefit from the provisions of the Inflation Reduction Act. This act caps insulin costs at $35 per month or $55 for a box of 5 prefilled pens and separates them from the beneficiaries’ deductibles. This makes paying full price for insulin products a thing of the past for those with Part D coverage.

State-mandated caps

But what about the other half? Diabetics who are not on Medicare might enjoy a cap as well, depending on their state. As of 2023, 20 states and D.C. have insulin price caps ranging from $25-$100 on insulin. However, this information is deceptive: if an individual has employer-sponsored coverage, this cap cannot be enforced until it is brought up to the federal level. While attempts to extend this are in the works, they have not made it to Congress quite yet.

Partnering with the right carrier

Those with group coverage are not left high and dry, though. Blue Cross Blue Shield Association and UnitedHealthcare introduced new policies in 2023 to help with insulin costs. BCBSA has partnered with Civica to produce and distribute insulin biosimilars and generics, which should tout a much smaller price tag. This program should be in full swing by 2024.

What works best?

Taking all of this into consideration, we can see that while Medicare beneficiaries are going to benefit the most from these new regulations, there are some ways that those of us who are not 65 quite yet can take advantage of some savings as well. As caps look to spread to the federal level for group insurance, companies can keep these benefits in mind when choosing a carrier, and individuals can keep caps in mind when shopping on the market. Until then, keep those manufacturer coupons on standby.