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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Private sector efforts to lower cost sharing for insulin continue but patient advocates and lawmakers still believe legislation is needed to tackle the issue in a comprehensive way.
US legislation attempts to address manufacturer, pharmacy benefit manager impact on patient costs in addition to health plan benefit designs. Critics suggest it’s too easy on manufacturers but that may help its chances with Republicans.
The legislation would also establish new manufacturer discounts in Medicare Part D as part of a redesign of the benefit that includes a cap on beneficiary out-of-pocket spending. Negotiations are still fluid on the overall legislative package, however, and things could change.