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?
Answered by 12 licensed agents
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.
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.
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.
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.
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!!
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.
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.
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.