Insulin Out-of-Pocket Costs in Medicare Part D

(By Juliette Cubanski and Anthony Damico for Kaiser Family Foundation published July 28, 2022)

Addressing the cost of insulin continues to be at the forefront of policy discussions around prescription drugs. Legislation has been introduced in Congress that would cap monthly copayments for insulin products at $35 for people with Medicare and private insurance, require the federal government to negotiate insulin prices, and encourage insulin manufacturers to lower list prices. To inform discussions about these proposals, this analysis updates prior work from KFF on out-of-pocket spending on insulin products by Medicare beneficiaries enrolled in Part D drug plans, along with state-level use and spending data, based on prescription drug event claims data through 2020 from the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse. Available claims data predate the 2021 introduction of the CMS Part D Senior Savings Model in which enhanced Part D drug plans charge a monthly copayment of no more than $35 for selected insulin products. Therefore, this analysis does not reflect any potential cost savings for Part D enrollees who have enrolled in these plans since 2021. Continue reading here…

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