I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet?

Question

Angela Ellington · Accepted Answer

It's a good idea to review your Part D coverage every year with a Licensed Broker for this reason. Formulary covered insulins are capped at $35, but it's possible that the brand that you use is no longer on your Part D formulary. The Inflation Reduction Act created a $2000 catastrophic limit in 2025, but if your drug is not on the formulary, it won't count toward the calculation, either.

Answered by Angela Ellington on April 14, 2025

Agent Licensed in CA, AZ, FL & 9 other states

Answered by Angela Ellington Medicare Insurance Agent

Tony Capraro III · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/-ive-had-the-same-part-d-plan-for-years-but-this-year-my-insulin-shot-up-in-price-did-the-inflation-reduction-act-not-fix-this-yet#tony-capraro

Christopher Palazzini · Answer

You should be shopping out a Part D plan every single year. No matter what. Whether your meds changed or not. Part D plans change their formularies every year. Inflation reduction act will not help you if the RX is not on the formulary list. Co pays and annual deductibles can apply as well.

Answered by Christopher Palazzini on March 30, 2025

Broker Licensed in FL, CA, GA & 6 other states

Answered by Christopher Palazzini Medicare Insurance Agent

Melanie Baxter Black · Answer

The Inflation Reduction Act ensured that Medicare beneficiary would an annual $2,000 maximum out-of-pocket expense. For purposes of the payment plan, the year begins on January 1st of each year and ends on December 31st of each year. The Inflation Reduction Act provides an optional payment plan that would allow you to get your medications without payment at the pharmacy at the time of pickup. You would receive a monthly billing for all of your copays for payment up to the $2,000 annual maximum out-of-pocket expense. You have until December 31st of each year to pay it off. Once you opt into the payment plan, you cannot opt out for that year -AND- ALL of your prescriptions are included in the payment plan. You may not pick and choose which presctiptions you want on the payment. Prices of your insulin are decided on by the Part D presctiption drug plan carriers. The Inflaction Reduction Act does not affect individual drug pricing.

Answered by Melanie Baxter Black on May 19, 2025

Agent Licensed in TX

Answered by Melanie Baxter Black Medicare Insurance Agent

Michelle Simonds · Answer

Yes, the IRA capped out of pocket costs for insulin at $35/month. However, this cap only applies to insulin products that are covered under your specific Part D plan's formulary. If your formulary has changed, you might be paying more. I can assist you in reviewing your options and finding a plan that meets your needs.

Answered by Michelle Simonds on May 5, 2025

Agent Licensed in PA, FL & NY

Answered by Michelle Simonds Medicare Insurance Agent

Steven Bleicher · Answer

Someone has not brought you up to speed. You always have choices. First of all, please do not forget to read your "ANOC" or Annual Notice of Change which is mailed to you every October which compares the current year costs to the following one. My guess is that you are paying much more premium per month since you don't have the means of checking other plans in your particular State. What is elusive is that a Part D plan can delete a drug that you take and you'd not know that this has occurred. Therefore, it is ESSENTIAL for you to call your company's customer service department, asking for a supervisor and determine which of your drugs are not a part of their drug formulary for the next year. 

Insulin Price Cap: If you use insulin, Medicare capped monthly insulin costs at $35.00 apiece which began in 2023. Don't let a drug store clerk tell you that it is not $35.00 since they know nothing about Medicare and the Inflation Reduction Act. Furthermore, No-Cost Adult Vaccines: since 2023, vaccines under Medicare Part D are available at no cost to adults which can keep you protected without unexpected expenses. However, we cannot predict if insulin may be on the rise in the future due to our global economy. 

However, NEVER simply retain the original Part D plan that you started with, since the volatility of pharmaceuticals is rampant at this time. Always use Medicare.gov and investigate if from one year to the next, not just insulin but all of your Rx's may have changed "TIERS". There are five drug tiers: Tier 1 is Preferred Generic, Tier 2 is Non-Preferred Generic, Tier 3 is Preferred Brand Name, Tier 4 is Non-Preferred Brand Name, and Tier 5 is a Specialty drug which is very expensive. The lower the tier, the cheaper the copay. Plus, be sure to use your plan's "Preferred" pharmacy & not the closest one to your home or the one with a drive-in window. That could cost you a lot of $$ over a 1 year time!!

Andrew Zurbuch, MBA · Answer

That is a great question. From my understanding the Insurance Companies for 2024 Part D coverage didn't have to cover all Rx insulins. A Medicare Beneficiary whom is concerned about their Rx costs for the next year should meet with a Broker during the Open Enrollment.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Rene Casanova · Answer

The IRA did limit copays for insulin to $35 a month.  This is applied to all Prescription Drug plans.

Steve Brauer · Answer

Something does not sound right...insulin costs are capped at $35 each month. I would check with your broker if you are being charged more than that.

Eizel Mere · Answer

Part D plans change every year, prescriptions change tiers and with this price change occurs. It is important to go over the Part D plan every year to make sure it is still the best one for you. For a Part D Plan you can only make changes during AEP and OEP.

Answered by Eizel Mere on April 9, 2025

Broker Licensed in FL

Answered by Eizel Mere Medicare Insurance Agent

Diana Pedersen · Answer

Each year, you should sit down with a licensed Medicare Broker to have them verify the best plan for you based on your current medications, so you can be on the right plan based on your needs for the following year. The Inflation Reduction Act is mean to lower prescription drug prices. Certain insulins are capped at $35 per month, while others can be higher. The cost for copays of covered prescriptions, as of 2025 due to the Inflation Reduction Act, has a catastrophic limit of $2000 for the year.

Answered by Diana Pedersen on April 28, 2025

Agent Licensed in WA & ID

Answered by Diana Pedersen Medicare Insurance Agent

Rene Apack · Answer

I am very sorry that you kept the same Part D plan because you most likely overpaid out of pocket money that you did not have to.

Out-of-pocket costs change every year for all kinds of reasons.
It's in your best interest to shop your Medicare Prescription Drug Plan, Plan G, between October 15th and December 7th.

Get a Free consultation with me.

Best wishes,

Rene Apack 
847-917-4870

I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet?

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I've had the same Part D plan for years, but this year my insulin shot up in price. Did the Inflation Reduction Act not fix this yet?

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