I can only find 1 Medicare insurance D plan that will cover Tresiba and apparently they can charge however much they want. I thought that they had to charge $35.00 for each pin, but this company wants to charge over 400.00 for 5 pens.
No plan will cover any of my Praulent injections which I must take and that is $530 to $900 for one month. If the drug isn’t in the formulary then you can’t include it into the $2,000 maximum amount for the year.
Has any person on Medicare had any luck getting Tresiba covered?
Wasn’t that a thing where congress was patting themselves on the back and saying, “Look what we did! You can’t be charged more than $35 now! Aren’t we great!!!”
Your Medicare drug plan can’t charge you more than $35 for a one-month supply of each Part D-covered insulin product, and you don’t have to pay a deductible for your insulin.
The insulin has to be on the Part D plan formulary in order for the $35 copay cap to apply.
I too thuoght 110.00 was all that they could charge, but I read something different when I looked this up. I am going to call Tresiba tomorrow. It is confusing.
My primary insulin source is covered by Medicare Part B since I use a pump. My back-up insulin in case my old pump fails, is Tresiba for the basal.
Your post caused me to check the formulary of my 2025 Part D plan, Wellcare Value Script. It showed the status of Tresiba as “non-formulary” but it did show that insulin degludec as covered with a Tier 3 status.
It showed that degludec insulin comes as u-100 and u-200 in a 3 mL (300 unit) pen. The formulary also lists a 10 mL vial.
I understand that degludec is the same insulin but unbranded. I didn’t know that Tresiba had an unbranded equivalent.
It’s not as important to me since it is emergency back-up only. While I have plenty of Tresiba 10 months past expiration, I do want the ability to economically secure my back-up insulin, if needed.
Perhaps this might help with your situation. Good luck!
If you aren’t sure how to access your plan’s formulary let me know your plan name and what state you are in and I’ll find a link to it for you. Then we can search it for Tresiba and, per @Terry4’s excellent suggestion, insulin degludec.
I actually knew that I could use degludec, so I was also looking for that word while looking for Tresiba. I finally called my insurance company and they said that as long as I had a letter from my doctors, saying that I need both Tresiba and Praulent then they will both be covered.
I didn’t push getting Novolog covered, because I have used Humalog before without a problem if I am remembering correctly.
I am going to ask my doctor to include Afrezza, because the insurance company covered it last year.
Thanks so much for the help. I am breathing much easier now.
It is supposed to be no more than $35 a month so that should depend on how many pens you use a month. Regardless, it isn’t clear if it is for all insulin so that might be the catch.
If you have problems with the amount charged for Tresiba or Novolog pens, check the prescription – the prescription should be written for the quantity of the substance you need per month, not for the number of pens. (According to my pharmacy … it may have been wrong but this tweak removed the billing problem I had.)
My GP writes my Tresiba prescription for the amount I say I use rather than the pens I need. I get 5 pens every 3 months and am charged 105. So, $35.00 monthly.
My insurance changed recently and now I pay more for insulin.
I get it in 3 month sets. It was $90 under my old insurance, 30 per month. Now it’s 280 per 3 months but after my 1000 deductible, it’s free to me, so it works out the same in the end.
That $35 a month cap is only for Medicare. Otherwise there is no limit for us on private insurance.
It is only for Medicare for now, but in the works to be expanded. Will see if and when that happens. Furthermore, the insulin must be on the insurance company’s formulary.
