Insight

Part D senior savings model for insulin coverage

CMS just announced alternative Part D options that lower seniors’ cost-sharing for insulin, according to the attached issue brief.

Larry Kocot

Larry Kocot

Principal, Advisory, KPMG US

+1 202-533-3674

The new Medicare “Part D Senior Savings Model” -- introduced by CMS on March 11 -- is designed to test the impact of lower, flat-rate copays taking formulary insulins offered by participating manufacturers.  Designed to increase adherence and improve health outcomes for seniors with diabetes, the plans cover both vial and pen dosage systems for at least one each of the following insulin types:  rapid acting, short acting, intermediate acting, and long acting.

The new model is made possible by having manufacturers provide more funding for patient claims that are subject to the coverage gap discount program.  Only plans designated as “advanced plans” are eligible for the model, while catastrophic coverage (i.e., beyond the coverage gap limit) will not be included.  At present, all major insulin manufacturers – Eli Lilly, Novo Nordisk, and Novo Nordisk Pharma-- have formally applied to participate, so there is no reason to expect any disruption to formulary placements or rebates.

For more detailed information on what “Part D Senior Savings Model” means for your organization, please click here to read the attached issue brief.


 

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