A Win for Diabetic Medicare Patients: Medicare Match Updated to Reflect Insulin’s New $35 Monthly Price Cap

Diabetic seniors on Medicare are finally getting some relief. Earlier this year, Congress passed the Inflation Reduction Act of 2022, which — among other provisions — caps the cost of insulin at $35 per month for Medicare patients. Let’s take a closer look at what that means for seniors and for pharmacies using Medicare Match by EnlivenHealth® to help them compare plans:

How Does the Inflation Reduction Act Impact People Who Use Insulin?

Starting in 2023, diabetic seniors with Medicare coverage — including those who use insulin pumps — won’t pay more than $35 per month out of pocket for their lifesaving insulin. While roughly one-third of Medicare Part D plans already offer $35 insulin, this legislation ensures that all seniors on Medicare can benefit from this out-of-pocket cap. By 2026, changes in Part D prescription drug pricing could lead to even more insulin savings for seniors.

As a safeguard, any Medicare beneficiaries who pay more than $35 per month for their insulin after the legislation goes into effect will be reimbursed, according to the American Diabetes Association. Plans must reimburse patients within 30 days for any cost-sharing amount collected at the point of sale that exceeds the monthly cap.

What Impact Will the Inflation Reduction Act Have on Other Costs?

Also included in the Inflation Reduction Act is a $2,000-per-year cap on the cost of all prescription drugs for Medicare Part D patients. Since patients with diabetes account for one-third of all prescription drug costs in the U.S., this will be a huge financial help to diabetic seniors. Unfortunately, patients will have to wait a little longer on this one; this change doesn’t take effect until 2025.

How Does This Affect Prices on Medicare.gov and Other Plan Finders?

Since the legislation changes are so recent, the $35 cap introduced by the Inflation Reduction Act may not be shown accurately on most Medicare plan comparison platforms, including Medicare.gov. We expect that plan costs will be up to date once the Act goes into effect on January 1, 2023.

How Will This Affect Medicare Match?

Medicare Match by EnlivenHealth® will function as it always has. Depending on the supply amount and other cost calculations, insulin costs shown will be a maximum of $35, $70, or $105 for a 30-day, 60-day, or a 90-day supply, respectively.