Do you have Diabetes, use Insulin, and are on Medicare?

If the answer is yes, and you’re paying more than $35 a month for insulin, keep reading….

In 2021, Medicare introduced a pilot program called the Senior Saving Model  (SSM) with the aim of reducing the cost of insulin to people on Medicare and improving the quality of their health care.

Who is eligible for this discounted insulin program?

  • People that have diabetes and are prescribed insulin
  • People that are enrolled in Medicare Advantage (MA-PD) plans or Medicare Prescription Drug Plans (PDP) that agreed to participates in the SSM.
  • People that take insulin from manufacturers that participates in the SSM.

What insurance companies and plans participate in the SSM?

There are a variety of insurance companies that sell Medicare Advantage (MA-PD) and stand-alone Prescription Drug Plans (PDP) ranging from large for-profits such as United HealthCare, Humana & CVS to regional non-profits such as BCBS affiliates to small plans with limited subscribers.

To illustrate, in Rochester, NY with a metropolitan population of over 1 million, there are 22 Medicare Advantage plans offered by 5 major insurers: Excellus (BCBS), MVP, CVS/Aetna, United HealthCare, and Wellcare. These insurers sell 22 different MA plans, however, only 4 plans from Excellus and 4 plans United HealthCare participates in the $35/mo. insulin SSM program.

In addition, there are 19 prescription drug plans (PDP) offered in Rochester to individuals that choose to enroll in either Original Medicare or a Medigap plan. Not all PDP insurers participate in the SSM program and not all of their plans include the $35/mo. insulin.

Some insurers offer discounted insulin in their plans with higher monthly premiums. So, you need to carefully evaluate the total cost of each plan including the premium, deductibles, and the price of your prescriptions, with and without the discounted insulin. A plan with discounted insulin may not be the lowest total cost plan when you include the total costs of the plan and all of your medications.

What Insulin brands participate in the SSM program?

Insurers that participate in the SSM program are required to include at least one vial and one pen dosage form for each of the different types of Model insulins, where available and including – rapid acting, short-acting, intermediate-acting and long-acting – all for at a maximum $35 copay for a one-month supply.

Participating Insulin Manufacturers include:

  1. Eli Lilly and Company
  2. MannKind Corporation
  3. Mylan Specialty L.P.
  4. Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
  5. Sanofi-Aventis U.S. LLC

How can you find out if your current plan or other plans available to you, participates in the $35/mo. SSM program and what specific insulins are included?

  • Call your plan’s member services (number is listed on the back of your card)
  • Ask your pharmacist
  • Call & ask Medicare at 800-633-4227
  • Check online at Medicare.gov/plan-compare. 

With the online http://www.medicare.gov/plan-compare, after you input all your medications, you will see an estimate of your total annual out-of-pocket expenses for each plan that you are considering, and for each of your medications and the pharmacy that you select.

Please keep in mind, the Medicare Open Enrollment period end on December 7th, for changes in MA-PD and PDPs that will become effective January 1,2022.

Best wishes

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