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Medicare Part D and Insulin Affordability — The Devil Is in the Details

  • Stacie B. Dusetzina, Ph.D., Haiden A. Huskamp, Ph.D., Laura M. Keohane, Ph.D., and Nancy L. Keating, M.D., M.P.H.

Among the discussions under way in the U.S. Congress regarding drug pricing and access, those related to insulin are particularly prominent. It is clear why: millions of Americans rely on insulin, and reports about cost-related underuse1and subsequent deaths, primarily among uninsured or underinsured people, have proliferated in the popular press. But affordability of insulin may also be a concern for Medicare beneficiaries. Medicare spending on insulin now exceeds $13 billion annually before accounting for manufacturer rebates.2Experts have called for reducing out-of-pocket spending by Medicare beneficiaries who need insulin,3including by requiring plans to share rebates with patients or allowing the government to negotiate for lower list prices for insulin products. Most recently, the Trump administration announced its intention to reduce older adults’ out-of-pocket costs for insulin by allowing some enhanced alternative Part D plans to provide insulin at a $35 copayment for a 30-day supply under the Center for Medicare and Medicaid Innovation’s Part D Senior Savings Model.4

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