The Inflation Reduction Act and insulin prices

If you’re a senior with diabetes, you know how important insulin is. You also probably already know that the average annual insulin price rose 55% from 2014 to 2019.¹ This price increase makes buying life-saving insulin a challenge for many seniors.

New legislation—the Inflation Reduction Act—will make insulin more affordable.

What does the Inflation Reduction Act do? The most important change for seniors with diabetes is the insulin price cap. The act caps insulin prices at $35 a month for people on Medicare. This price cap also applies to insulin taken through a traditional pump.

The legislation comes at an important time for many seniors with diabetes. More than 5 million people with Medicare struggle to afford their prescription medication.² Rising insulin costs can prevent people with diabetes from treating their disease. 1 in 4 people on insulin reported reducing use due to cost.³

Although the law was passed on Aug. 16, 2022, the new price guidelines for insulin don’t go into effect until 2023.⁴

When is the price of insulin coming down?

Starting Jan. 1, 2023, anyone enrolled in a Medicare prescription drug plan will not pay more than $35 for a month’s supply of insulin. This applies to any insulin that is covered by a Medicare prescription drug plan and dispensed through a retail or mail-order pharmacy (such as CenterWell™).

Starting July 1, 2023, anyone with traditional Medicare who takes insulin through a pump will not pay more than $35 for a month’s supply. This applies to someone using a pump covered through Medicare Part B.

The act also states that a member’s deductible will no longer apply to insulin costs. A deductible is the amount a member pays before Medicare pays.⁵ Before the Inflation Reduction Act goes into effect, you would pay your deductible cost before your insurance paid their portion of insulin costs. After the act goes into effect, your plan will now pay their share of insulin costs without you paying the deductible amount first.

How will the Inflation Reduction Act affect someone without diabetes?

If you don’t need insulin, the legislation may reduce your healthcare costs in other ways. Other changes made by the law include:⁶

• Rebates for rising drug costs. Starting on Oct. 1, 2022, drug manufacturers will be required to pay rebates to Medicare if their prices for certain Medicare Part D drugs increase faster than inflation over the course of a year.
• No-cost adult vaccines. Starting in 2023, anyone with Part D can get adult vaccines (including the shingles vaccine) at no cost to them.
• Changes to catastrophic coverage. Starting in 2024, if your drug costs reach the catastrophic coverage phase in your Part D plan, you won’t pay a copayment or coinsurance.
• Expanded subsidies. The Part D Low-Income Subsidy program is expanding. Starting in 2024, the program is available to those who earn less than 150% of the federal poverty level.
• Drug cost caps. Starting in 2025, your drug costs for Part D will be capped at $2,000.

Another big change will take time—but should result in lower drug costs for seniors. For the first time, Medicare will be able to negotiate directly with drug manufacturers for the price of brand-name Part B and Part D drugs that have no competition.

In 2023, the Centers for Medicare & Medicaid Services (CMS) will select 10 drugs for this program. The drugs will likely be single-source drugs with limited competition⁷—some of the more expensive drugs on the market. Once selected, CMS will bargain directly with manufacturers to set the cost. The cost change won’t happen until 2026. However, the negotiation process is seen as an important step in improving competition and lowering costs.

Do I need to do anything to get the benefits of the Inflation Reduction Act?

No—just review your plan every year to make sure it still meets your needs.⁸

If you do have diabetes and need insulin, we recommended that you get help picking a plan that’s right for you, especially as these changes roll out for 2023. Call 1-800-MEDICARE or contact a state health insurance plan (SHIP) counselor in your state to learn more.

How CenterWell Pharmacy can help

As the many changes from the Inflation Reduction Act take effect, it’s more important than ever to have a smart pharmacy team that you trust. Your pharmacy team can help you understand upcoming Medicare changes, whether or not your plan covers over-the-counter items, or if simple changes to your prescriptions could save you money. At CenterWell Pharmacy®, we’ve been helping our members find the best cost for their medications for a long time. And, with 24/7 support, you can call us any time. Our knowledgeable pharmacists are educated on the changes coming with the Inflation Reduction Act—as well as any other questions you may have.

And, as a mail-order pharmacy, CenterWell gives you safe, secure and convenient access to your prescriptions. Fill or transfer your prescription today to enjoy the benefits of CenterWell, including having a trusted partner through recent Medicare changes.

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Transfer an existing prescription

You can also call us at 800-379-0092 (TTY: 711), Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. – 6:30 p.m., Eastern time.

Disclaimer: This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional. You should consult with your doctor to determine what is right for you.

Sources

1. Chien-Wen Tseng et al., “Impact of Higher Insulin Prices on Out-of-Pocket Costs in Medicare Part D,” Diabetes Care Volume 43, Issue 4 (April 2020): 50–51, accessed November 1, 2022, doi:10.2337/dc19-1294.
2. “The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans,” Centers for Medicare and Medicaid Services, last accessed November 1, 2022, https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-lowers-health-care-costs-millions-americans.
3. “Impact of Higher Insulin Prices on Out-of-Pocket Costs in Medicare Part D.”
4. “Inflation Reduction Act: CMS Implementation Timeline,” last accessed November 1, 2022, https://www.cms.gov/files/document/10522-inflation-reduction-act-timeline.pdf.
5. “What is the Medicare Deductible?” National Council on Aging, last accessed November 1, 2022, https://www.ncoa.org/article/what-is-the-medicare-deductible.
6. “Saving money with the Inflation Reduction Act,” Medicare.gov, last accessed November 1, 2022, https://www.medicare.gov/about-us/prescription-drug-law.
7. “Reduced Drug Prices, Enhanced Medicare Benefits Under the Inflation Reduction Act Frequently Asked Questions (FAQs),” Centers for Medicare & Medicaid Services, last accessed November 1, 2022, https://www.cms.gov/files/document/10522-external-faqs-about-inflation-reduction-act.pdf.
8. “Selected Health Provisions of the Inflation Reduction Act,” Congressional Research Service, last accessed November 1, 2022, https://crsreports.congress.gov/product/pdf/IF/IF12203.