For Those With Diabetes On Medicare Part D, Insulin Is $35…If It’s Covered

Open Enrollment began October 15, and I tackled one of our first reviews for a long-time client. Alicia has had the same drug plan since 2018 when she started on Levemir insulin. It was quite a surprise when she learned that her plan would drop this drug from its formulary in 2024.

Alicia was frustrated because she thought the Inflation Reduction Act capped all insulins at $35. I suspect many people believe that. Headlines like, “Senior citizens won’t pay more than $35 a month for insulin as new drug provisions kick in,” can give that impression. However, as they say, the devil is in the details. In a frequently asked questions document, the Centers for Medicare and Medicaid Services stated that, “if an insulin is a covered insulin product, the $35 cap for a month’s supply for each insulin product applies, as of January 1, 2023.” CMS defines covered insulin as one that is included on a Part D sponsor’s formulary, the list of drugs that a plan covers. The FAQ document also notes a plan can change its formulary, which includes adding or removing drugs.

More plans are changing coverage of insulin

This raised a question. Are other drug plans changing their formularies in response to this new rule? I decided to do a quick check of the 22 stand-alone Part D plans sponsored by eight insurance companies in Alicia’s area. I identified 10 insulins that 65 Incorporated clients take in five categories: rapid-acting, short-acting, intermediate-acting, long-acting and mixed. Here are some of my observations.

• Eight plans will not make changes to their insulin coverage in 2024. The number of insulins these plans don’t cover ranges from three to seven.
• Four plans actually removed insulins from their noncovered lists, meaning they will cover more next year. One plan removed one and three plans, two.
• That leaves 10 plans that will cover fewer drugs next year than they do this year. Of note, four plans will drop four insulins from their formularies.
• The number of insulins that are covered this year but won’t be next year range from one (two plans) to seven (five plans). (Click here to see a chart.)
• The costs may vary.
• I also found that many Medicare Advantage plans are changing their coverage of insulin.

Levemir in particular got my attention because of Alicia’s situation. I discovered her plan is not alone in changing its formulary. Nine other plans that are dropping this drug next year will join the seven that didn’t cover it this year, leaving only five with Levemir on the 2024 formulary.

And that creates a major problem for Alicia. Those five plans do not cover two other very important drugs she takes. She is meeting with her physician to discuss some alternatives, with the hope of finding a plan that would work for all three medications. These changes could disrupt Alicia’s control of her diabetes or other conditions.

There are other insulins I did not include and this review is not a scientific study. You may not live in Alicia’s town but a plan’s list of covered and noncovered drugs is consistent from one area to another. If you have diabetes and use insulin, hopefully, you’ll take the time to check out your drug plan. Will it still cover your insulin? If it doesn’t, check other plans. You still have time. Open Enrollment ends December 7.