Part D, Insulin and the new $35 Cap?

[Medigap Bill]

For those that run Part D reports for clients and/or actually do the Part D product. Is running insulin on the report going to even matter anymore if everything is capped at $35?

For example, a person is on 8 total meds but 4 of them are insulin related. Do you save yourself time and leave off insulin now? Why run them if you already know its $35?

I always found it difficult to tell if it was going to be covered under Part B or Part D anyway. Especially for T65 and complicated diabetic cases.

 

[kgmom219]

It has implications to the Coverage Gap/Donut Hole accumlator

 

[straightnochaser]

If you aren't doing the bare minimum (running prescriptions to get an accurate annual total) what are you even doing? It takes a couple minutes... imo this is one industry where cutting corners or taking short cuts is just asking for trouble.

 

[ValeRosso]

I think the $35 cap applies to each covered insulin product. Maybe someone can verify this.

 

[somarco]

a person is on 8 total meds but 4 of them are insulin related. Do you save yourself time and leave off insulin now? Why run them if you already know its $35?

You need to run reports every year, including the initial enrollment.

The $35 cap does not apply to all insulin medications (unless things have changed). The insulin(s) your client uses may not be on the formulary for the $35 copay.

 

[straightnochaser]

$35 cap applies to all insulins covered by the formulary

 

[straightnochaser]

I think the $35 cap applies to each covered insulin product. Maybe someone can verify this.

It does

I found a couple links that show each covered insulin.. I am sure each carrier has the same I just dont have time to pull all of them at the moment.

 

[hockeyday]

For those that run Part D reports for clients and/or actually do the Part D product. Is running insulin on the report going to even matter anymore if everything is capped at $35?

For example, a person is on 8 total meds but 4 of them are insulin related. Do you save yourself time and leave off insulin now? Why run them if you already know its $35?

I always found it difficult to tell if it was going to be covered under Part B or Part D anyway. Especially for T65 and complicated diabetic cases.

what is insulin related? I hope your not thinking Diabetic meds..

 

[DS4]

$35 cap applies to all insulins covered by the formulary

This!

 

[Medigap Bill]

I ran a report yesterday with insulin meds included. A pop up in several different locations on Gov site stated the following:

"IMPORTANT! The cost of a one-month supply of each Part D-covered insulin is capped at $35. If you get a 60- or 90-day supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin."

You need to run reports every year, including the initial enrollment.

The $35 cap does not apply to all insulin medications (unless things have changed). The insulin(s) your client uses may not be on the formulary for the $35 copay.