Open enrollment is a time for making changes to one’s part-D plan. Having set up one a few years ago I would just let the thing renew, expecting the usual
small changes in costs for premiums, drugs, deductibles, etc. Recently I received some VERY unhappy news about insulin coverage from my ins. carrier. They are dropping coverage for Humalog entirely, period. I’m still in shock. I then went to their web site to see the formulary for confirmation. I then called their people (twice) and got the same news. Oh, and they’re dropping Lantus too. This company is a major player, not some fly-by-night. I conducted the same research with 8 other large carriers and only 2 of them are still covering Humalog.
Now, thanks to the law passed in 2022 insulin Rx’s are capped at $35. And this has been the case for me ever since. But when you read the language of the law it refers to “covered” drugs. So if an insurance company is no longer covering an insulin does that mean they don’t have to adhere to the $35 price cap and we have to pay the full retail price in 2024? The reps at my company were equally surprised, having not been told of this even by their own managers. So, how is this going to work? Thanks for your comments.
To answer this and many other Medicare coverage questions I highly encourage that people use medicare.gov. It’s a bit of a learning curve to become proficient but is well worth the effort so that you can gain access to a primary source of information.
Insurance companies and pharmacies can help but they are secondary players like you. Their customer service reps may be well-intentioned but may not understand the whole situation and may give unintentional yet still misleading info.
Also be aware that this poster is asking a question about Part D Rx plans of standard Medicare, not Medicare Advantage! This blurring of the actual line of these two distinct programs is a source of endless miscommunication and confusion!
If the insulin is not on the plans formulary it will not be covered. Novolog is probably preferred and on formulary and will be $35 Personally i can not use Novolog. They are treated as interchangeable but for many of us they are not. Isn’t an Aetna plan? They definitely have novolog only formulary
Yes, only certain insulins + they have to be on the insurance formulary to be at the $35 cap. The best plans I have found so far for Pard D coverage of Humalog are:
Clear Spring Health Value Rx (PDP)
Clear Spring Health | Plan ID: S6946-060-0
Mutual of Omaha Rx Essential (PDP)
Mutual of Omaha Rx | Plan ID: S7126-105-0
My total annual cost for my insulin + premiums + deductibles for all my drugs will run about $1,300 for 2024.
Yes I am finding same issue. NO COVERAGE for Novolog and Humalog. Some for Lispro but not seeing the $35 coverage for the fast acting. So Tresiba long acting is ok. Found this on Medicare site. Very scary.
