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US Medicare Insulin Demo Could Expand To Other Drugs

Executive Summary

Eighty-eight insurers who offer Medicare Part D plans are interested in the demonstration project, which would limit insulin copays to $35.

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Insulin Copay Bill Advances In What Could Be US Senate Democrats Last Gasp For Price Reform

Though popular, the proposal to cap insulin copays is a relatively minor part of the drug pricing reform package included in the stalled Build Back Better Act. But it may represent Democrats’ best chance of passing any drug pricing-related legislation while they still hold majorities in Congress.

CMS Innovation Center Exploring ‘Array’ Of Cost-Lowering Medicare Payment Models

CMMI payment demonstrations are viewed as way of skirting statutory obstacles to experimenting with new approaches to reimbursement and could lead to significant drug pricing reforms if legislative efforts fail. However, HHS is not signaling an intent to pursue transformational new models at this point.

Part D Demos: Insurer Participation In Insulin, Catastrophic Risk Sharing Models Varies Widely

Almost a third of Medicare drug plans are expected to offer the insulin demonstration next year, while almost none have signed up for the payment ‘modernization’ demo, under which plans would be at more risk for spending during the catastrophic phase. The Centers for Medicare and Medicaid Services also announces basic Part D premiums will average $30.50 for 2021.

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