Have you had a 3 month insulin prescription filled? If so, did you pay $35 for the 3 months or $105 for the 3 months?
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$105 for 3 months, however, you can get creative about it. Take the greatest amount you ever use in one day, multiply that by 30 and ask your provider to prescribe you at least that amount for each 30 days. When I travel to certain countries where diet is high carb and they use a lot of sugar in everything, I use almost three times as much insulin as I use in the US so I have used that as my base request at times. Now, after so many years, my endo just asks me how much I want her to prescribe and that is what she prescribes so it usually takes me about 7-8 months to go through a 90 supply of insulin.
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Thank you for your response. I manage my brother’s healthcare. I’m going to have to crunch the numbers on all this.
When the $35/month limit was first announced I was still covered by private insurance through my former employer. Even though that initial limit was only to be applied to Medicare and wasn’t going to take effect until the next Jan 1, my cost for 90 days of insulin immediately dropped to $35. I didn’t start paying $105 for 90 days of insulin until I switched to Medicare.
I’m just about to start Medicare. With rapid plus long lasting insulin, thats two different insulins to fill. That’s pretty expensive for someone living on social security. I hate this disease!! I’ve been type 1 since 2012 and I’m still angry about it.
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I have paid so many different amounts with Medicare. I had Part D plans where my copay was $6 for 3 month supply and for 2 years it was $0 for 3 month supply. However the Part D premiums to get that low amount have continued to rise so I got a different Part D plan this year and asked my pharmacist to bill through Medicare Part B. The first time my coinsurance was $62. I just requested a refill and it will be $40 this time. There is no record of any transaction in my Medicare/AARP claims. I can’t figure it out.
$105 for three months. Personally think should be 0 copay. It’s an old medication. They have made their money on it.
So if you use Lantus, ( and Humalog or Novalog), is it $70 per month?
I saw in another topic your bother has a pump. That changes things. Did medicare pay for it? If so do you have a supplement insurance plan, aka medigap, aka Part G, K?, N or something plan?
Info from Medicare about insulin coverage and the difference between Parts B and D.
A current TuDiabetes topic on getting insulin for $0 with a Tandem pump, Medicare Part B and a supplement plan. Sometimes it is easy and sometimes…
Good for you taking care of your brother.
You are correct: insulin for a DME nondisposable pump is completely free under Part-B. Pharmacies often make the mistake of charging to your Part-D plan instead of charging to your Part-B plan. I have dealt with this issue for years. You need to tell your pharmacy to use your Part-B plan.
As you may have or not seen my posts on this issue. Under Medicare Part B…Medicare pays 80% and the remaining $35 monthly gets paid by your supplement. I’m constantly being given wrong information where I believe pharmacy staff keep confusing the $35 month cap that I believe Biden put through. They get really confused if you try to explain your supplement covers the remainder.
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My brother has had a Tandem pump for 9 yrs. It was being processed through Part B, but I think it was changed to Part D in 2024. I assumed it was part of the $35 rule. My brother was getting help from the state with prescriptions, so I wasn’t concerned about details. The state has just quit helping with prescriptions, so I’m trying to understand the details. To make matters worse, I think they might take the pump away from him. If so, he will have to pay for both Lantus and Humalog or Novalog. I’d like info on both situations, because I don’t know what’s going to happen.
2023 was the transition year for the $35 insulin copay cap and it did not go smoothly because Medicare also was changing the pump rules at the same time. Medicare, plans and pharmacies mostly had it sorted out by January 2024 I think.
I was wondering if your brother was a Type 1 or Type 2 diabetic to make sure I was giving you good info when I found in 2019 you said he had a Medicare Advantage Plan. https://www.medicare.gov/publications/12172-3-things-to-know-about-medicare-insulin-costs.pdf
3 If you use an insulin pump that’s covered under Medicare Part B’s durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your insulin costs won’t be more than $35 for a one-month supply.
To the official text I’d add “per drug”. Or “per prescription” if that makes more sense. Also note a plan can charge you less than $35 per month.
Medicare and Medicare Advantage are different. When talking about coverage issues with anyone please say Medicare Advantage or MA or even Medicare Part C. If a person has a MA plan they are not covered under Medicare Parts A or B or D. Your brother may also have coverage under a state Medicaid plan. Each state’s Medicaid plans are different. While this forum is great for a lot of diabetes adjacent help for this level of complexity you should stick to the professionals for your brother’s situation.
My brother has had a Medicare supplement ever since he turned 65. When he was on disability, he had to have Medicare Advantage. My brother is a Type 1.