Insulin cost cap

[w433458b]

My understanding is that insulin is capped at $35/month.  Prior to 2024 it was classified under tier 2 but in 2024 was reclassified under tier 3 which caused a $240 deductible which makes my monthly cost $55, what gives?

[AARPConsumerCare]

@w433458b, here you'll find some information: https://www.aarp.org/politics-society/advocacy/info-2023/medicare-insulin-questions-answers.html?cmp... - Diana G.

[GailL1]

@w433458b 

On Medicare - Medicare.gov - Saving money with the prescription drug law

It doesn’t matter the tier that the insurer puts it in - But remember this is for insulin - all types and lengths  - but it is not for dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 agonist like Januvia or Mounjaro or Metformin.

from the link ~

Part D insulin costs

Your Medicare drug plan can't charge you more than $35 for a one-month supply of each Part D-covered insulin, and you don’t have to pay a deductible. You’ll pay $35 (or less) for a one-month supply of each Part D-covered insulin product, even if you get Extra Help to lower your prescription drug costs.

If you get a 3-month supply of insulin, your costs can’t be more than $105 ($35 for each month’s supply).

Part B insulin costs (for insulin pumps)

If you use an insulin pump that’s covered under Part B’s durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month’s supply of Part B-covered insulin can’t be more than $35. The Part B deductible won’t apply. If you have Part B and Medicare Supplement Insurance 

that pays your Part B coinsurance, your plan should cover the $35 (or less) cost for insulin. 

If you get a 3-month supply of insulin, you'll generally pay no more than $105, because your costs can’t be more than $35 for each month’s supply of each covered insulin. 

It sounds like this is Part B covered insulin since the deductible for Part B is $ 240 for 2024 -  but they aren’t suppose to charge a deductible for it.

Medicare.gov - 5 Things to Know about Medicare Insulin Costs