Prescription drug plans that offer an insulin as a covered product will be required to cap the monthly costs of these products at $35.00 effective January 1, 2023. A covered product is typically defined as one found on the Part D plan’s formulary though there may be additional circumstances as well.
Beneficiaries should note that the $35.00 cap applies to approved insulin products under both Medicare Part D and also to insulin administered through a pump and therefore covered under the Medicare Part B medical equipment benefit.
If beneficiaries have any issues with choosing a Medicare Part D plan due to concerns surrounding this new benefit, they may be eligible for a Special Enrollment Period for Exceptional Circumstances or “SEP”. This SEP will run from December 8, 2022 through December 31, 2023. Beneficiaries who take insulin may add, drop, or change their Part D coverage one time during this SEP.
For more information on this and other Medicare coverage issues, feel free to reach out to the CHOICES program.