CMS Launches Groundbreaking Model to Lower Out of Pocket Expenses for Insulin | CMS

Today, under President Trump’s leadership, the Centers for Medicare & Medicaid Services announced the Part D Senior Savings Model, a voluntary model that enables participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs for insulin to a maximum $35 copay per thirty-day supply throughout the benefit year.

This Model will test a plan design for enhanced Part D plans that ensures that beneficiaries in participating plans will have predictable copays for a broad set of formulary insulins, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins, marketed by participating manufacturers from the beginning of the plan year and through the coverage gap phase.

The model is targeted to enhanced Part D plans that offer more generous prescription drug coverage than Part D basic benefit designs. These enhanced plans can reduce cost sharing beyond basic Part D plan types, such as fixed dollar copays instead of setting out-of-pocket costs to be a percentage of a drug’s price . In exchange for these additional benefits, enhanced plans have slightly higher premiums, which are paid for by beneficiaries or through other means, such as a Medicare Advantage plan.

CMSGov Here is a quick formula (Number of diabetes patients in the USA times the yearly dosage times the manufacturing cost (including payroll) plus distribution costs) divided by the number of diabetes patients. That is your per dosage cost. This does not include R&D reimbursement.

CMSGov Just another crazy idea but why isn’t our government stopping the price gouging by pharmaceutical companies? Patients shouldn’t have to go to another country for affordable medications

CMSGov How about working on the $3.2 billions lyme patients have to spend/year? Due to CDC stats- ignored LymeDisease patients for 45 years. Study just came out that their required test gives false negatives 7.1 times out of 10. CDC also told doc to only test in original 15 states.

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