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Reminder that all 2023 Medicare drug plans will offer some popular vaccines at a $0 cost and insulin for $35 or less per month.

Category: Your Medicare Plan Coverage
Published: Jan, 05 2023 10:01:47
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A number of provision included in the “Inflation Reduction Act of 2022” (IRA) will impact 2023 Medicare Part D prescription drug plan coverage including:
  • No cost for certain vaccines:  Medicare Part D prescription drug plan members will have no cost sharing for certain common vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), such as the Shingles vaccine and Pneumonia vaccine.

  • Cost for covered insulin will be $35 or less for a 30-day supply:  Insulin products included on a Medicare Part D plan formulary will have a $35 (or less) monthly co-pay and will not be subject to the plan’s initial deductible (if  any).  The monthly cost of insulin will remain consistent throughout the Medicare drug plan's Initial Coverage Phase, Coverage Gap (Donut Hole), and will not exceed the $35 co-pay in the Catastrophic Coverage phase (meaning that the cost of insulin will continue as $35 or less).

    This new low-cost insulin provision in the IRA is similar to the current Medicare Part D Senior Savings Model where 2021 and 2022 Medicare Part D plans had the option to offer "select" forms of insulin on the plan's formulary for a copay of $35 or less.  2023 Medicare drug plan will still be able to participate in the Senior Savings Model and, at the same time, implement the low-cost insulin provisions of the Inflation Reduction Act - which means that different insulin products on a plan's formulary can have different cost-sharing, but never more than $35 a month.

    In addition, beginning July 1, 2023, insulin furnished through Medicare Part B durable medical equipment (DME), will also have a monthly co-pay of no more than $35.

    No-cost vaccines and low-cost insulin products will be offered by both stand-alone Medicare Part D plans (PDPs) and Medicare Advantage plans that include drug coverage (MAPDs).



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