How the Insulin Savings Program Works
Some insulins are now $35/mo for people with Medicare.
But how does the program work and what’s covered?
The Inflation Reduction Act of 2022 made a variety of changes to Medicare aimed at lowering costs for seniors. One change was the “Insulin Savings Program”. For people with Medicare, this program limited the cost of certain insulins to $35 per month beginning this year.
$35 per month is a huge savings. The full price of Lantus, at the time of this writing, is a little over $500 per month. Even with Part D drug insurance many of our clients found insulin to be unaffordable. Previously with many Part D drug plans insulins would have a copay of between $35-60 per month, assuming they were covered at all. However, some drug plans also had annual deductibles of up to $480. This meant the first purchase of insulin for the year could be about $500. That just doesn’t work for people on a fixed income.
Additionally some clients would reach the coverage gap or “donut hole” in their drug plan at some point during the year. In the donut hole the cost of insulin would often rise from $40-50 per month to $125-175. Again, ouch if you’re like the many seniors that live on a fixed income with limited savings.
Starting January 1st 2023, seniors can kiss that old pricing system goodbye for certain insulins. Those insulins covered by the program should cost $35 each month for the whole year. No more expensive insulins in January or if you reach the donut hole.
Which insulins are covered?
A point of confusion among our clients and many others is which insulins are covered by the program? First understand that you must get your insulin through your Part D Drug plan, and your plan must cover the specific insulin you take. Some drug plans have a pharmacy network, where certain pharmacies are not covered as well.
An abbreviated list of the insulins covered include:
Humalog
Humulin
Novolog
Novolin
Lantus
Tresiba
Toujeo
Levemir
Basalgar
Insulin Lispro
These should be $35 per month now, however, again your Part D Drug plan must cover the insulin you take. If the insulin you take is not covered you will likely pay full price. Additionally if you qualify for Medicare Extra Help, you will pay less than the $35. Some with Medicare and Medicaid qualify for plans where the cost for covered insulins would be $0 per month. For a full list of covered insulins contact us, or visit the website The Medicare website here.
What’s Not Covered?
Another point of confusion is what’s not covered. Drugs that promote the natural production of insulin are generally not covered by the Insulin Savings Program. These include some of the following:
Januvia
Janumet
Trulicity
Ozempic
Victoza
Tradjenta
Unfortunately since the drugs listed above are not part of the Insulin Savings Program, Medicare beneficiaries will pay the amount determined by their Part D insurance, including deductibles, copays, and higher costs in the donut hole. However, help in reducing costs may be available through Patient Assistance Programs.
If you take a drug that is unaffordable, we’d be glad to check if you qualify for a program to help save on the costs.
*This article does not constitute medical, insurance, or legal advice. Information is true to the best of the authors knowledge at the time of publication.