Part D sponsors are required to include at least one vial and pen dosage form for each of the different types of Model insulins, where available – rapid acting, short-acting, intermediate-acting and long-acting – at a maximum $35 copay for a one-month supply through the deductible, initial coverage, and coverage gap phases of the benefit. Part D sponsors are encouraged to include additional insulin formulations, such as concentrated insulins, at the same $35 copay for a one-month supply. The Model doesn’t affect the cost sharing of insulin covered under Part B.
For a full list of the insulin drugs covered by each plan, as well as which drugs are covered under the Model, beneficiaries should review the drugs’ cost sharing on Medicare Plan Finder, as well as check the plan’s formulary.
Please contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121 with any questions or concerns.