New Medicare Part D model improves affordability of insulin

By Diana Ramirez, Special to the Herald

Diabetes is one of the costliest health problems in America. The American Diabetes Association (ADA) estimates that health care and other costs directly related to diabetes treatment, as well as the costs of lost productivity, can run $218 billion annually. And now, the financial burdens constantly plaguing diabetes patients have been compounded by the coronavirus pandemic. It’s due time that our lawmakers take action to address the affordability of care, and thankfully, the Trump Administration has elected to do just that.

On May 26, 2020, the Centers for Medicare and Medicaid Services (CMS) announced an immensely beneficial change to Medicare Part D’s approach to prescription insulin. More than 1,750 Medicare prescription drug plans and Medicare Advantage plans, working in partnership with insulin manufacturers, have applied to participate in the newly-announced Part D Senior Savings Model. The model will allow Medicare beneficiaries to choose from a variety of coverage options, each offering a broad set of insulins for only a $35 maximum co-pay per month.

The sweeping changes that the Senior Savings Model brings are certainly groundbreaking. CMS projects that the model will substantially lower out-of-pocket costs for insulin, from an average $675 per year to just $229—a savings of 66 percent. That level of cost-saving is nothing short of lifesaving, particularly for many senior Texans.

In Texas, more than 2.8 million residents—about 14 percent of the population—struggle with diabetes. These individuals require prescription insulin to regulate their glucose levels and stay alive. Unfortunately, the average person who lives with diabetes will spend more than twice as much in medical expenses than a person without diabetes. As a result, paying for insulin can be incredibly difficult, particularly when coronavirus lockdowns have stripped so many of their source of income.

This reality, coupled with the cost of insulin, can often lead many to choose between managing their condition and managing their pocketbook. And given that uncontrolled diabetes can lead to massive health complications like heart disease, kidney failure, amputation, and even death, the importance of access to insulin cannot be overstated.

By introducing plans that offer substantially lower out-of-pocket costs for prescription insulin, CMS is helping to alleviate the financial burden that many seniors face. The Senior Savings Model not only increases the accessibility of insulin, but it also establishes greater stability in terms of payment. Insulin users will no longer have to worry about falling through gaps in coverage or paying unexpectedly high prescription drug costs at the pharmacy.

Under this new model, Medicare Part D recipients can expect fixed, predictable insulin prices, and consequently, better health care outcomes.

This is a good first step forward, but there is more that can be done – like re-issuing the rebate reform rule that would require discounts and savings sucked up by middlemen be passed on to people at the pharmacy counter.

Texans should be pleased to see the Administration working to deliver better health care at lower costs – all while improving the lives of millions of insulin users in the process. And while Texas still has work to do when it comes to keeping our residents safe and healthy, CMS’ Medicare Part D Senior Savings Model is undoubtedly a crucial step in the right direction.

The Rio Grande Valley Diabetes Association (RGVDA) was established in 2007 and continues to strive to expand its programs and services to the community. Our board hopes that you will be able to take part in one of the many exciting events that we are offering this year and experience firsthand the pride we take in supporting our cause.

Our mission is to help prevent diabetes and its complications by providing educational services, early detection, and awareness to residents of Hidalgo County and across the Rio Grande Valley. For more information in regards to RGVDA, please call (956) 318-1900

Diana Ramirez is the executive director of the Rio Grande Valley Diabetes Association.