Seniors were rejoicing when the insulin part of the Inflation Reduction Act (IRA) went into affect on January 1, 2023. The IRA caps the cost of insulin at $35 per month for seniors who have Medicare – including those who use insulin pumps – starting in 2023. This legislation ensures that all seniors who use insulin benefit from this out-of-pocket cost limit.
The Inflation Reduction Act also makes changes to prescription drug pricing in Medicare Part D. Starting in 2026, seniors may pay even less than $35 a month for insulin. To make sure seniors are getting these savings, people who are charged more than $35 per month for their insulin in the first few months of 2023 should be reimbursed. If you did pay more than $35 for your insulin and you have not been reimbursed, you will need to contact your prescription drug plan. The phone number for member service's will be on the back of your card.
In addition to the insulin cap, starting in 2025 the IRA will be capping the cost of all prescription
drugs at $2,000 per year for seniors who have Medicare Part D. The IRA allows Medicare to negotiate the price of some of the most expensive prescription drugs directly with drug manufacturers, reducing the cost of these often out-of-reach medications to seniors.
Things to remember:
The insulin cap does not cover any non-insulin prescriptions, including those prescribed to manage diabetes.
Your $35 cap is in place as long as you use an in-network pharmacy. You can chose to go to a preferred pharmacy (lower copays for your other prescriptions) or a non-preferred pharmacy (higher copays for your other prescriptions).
If you get Part D Partial Extra Help, you will pay $35 (or less) for a month’s supply of a covered insulin product. People with Full Extra Help already have lower cost-sharing for insulin, and will continue to pay the lower amounts.
Insulin costs will still count toward your True Out-of-Pocket costs and your Part D deductible. It will also count towards your progression through the Part D coverage stages.
No matter what coverage stage you are in, your monthly copay for insulin will remain at $35.
Thank you for reading!
Jennifer