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Dear Avisery Members,
Under the Inflation Reduction Act, copays for insulin covered under Part B will be capped at $35 starting July 1, 2023.
BACKGROUND
In August 2022, the Inflation Reduction Act was passed which capped copays for each insulin product covered under Part D at $35 starting January 1, 2023. Additionally, the act capped copays for insulin covered under Part B at $35 starting July 1, 2023. The Part B and Part D deductible does not have to be met for the $35 copay to apply. The $35 copays for insulin also apply to Medicare Advantage plans that cover prescription drugs.
MEDICARE INSULIN COVERAGE
Medicare covers insulin through Part B and Part D depending on how it is administered. Part B covers insulin that is used with an infusion pump through Durable Medical Equipment (DME). Part D will cover insulin and the medical supplies used to inject the insulin with a prescription, if the insulin is on the Part D plan’s formulary. The $35 copay only applies to the insulin, additional medical supplies may have other cost sharing amounts and apply to the deductible. Medical supplies that Part D may cover include syringes, fillable pens, non-durable patch pumps, gauze, and alcohol swabs.
If you have any questions, please feel free to email avisery@ageoptions.org
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