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Which insulin will be covered for only $35 or less per month?


As part of the new CMS "Part D Senior Savings Model" (Model), about 30% of all 2021 stand-alone Medicare Part D plans (PDPs) and Medicare Advantage plans with drug coverage (MAPDs) will offer coverage of different types of insulin at a maximum co-pay of $35 per month throughout most phases of your drug coverage including your plan's: initial deductible, initial coverage phase, and the Coverage Gap (or Donut Hole) -- but, the Senior Savings Model does not apply to your Catastrophic Coverage phase (where you will pay 5% of the retail drug cost).

However, the new CMS model does not require all Medicare drug plans to offer this “supplemental coverage” of insulin -- and, as noted in more detail below, a Medicare drug plan that includes this fixed $35 (or-less) insulin coverage does not need to offer the coverage for all types or brands of insulin.

Please see the table below showing the different types and forms of insulin along with their National Drug Codes.

Please contact the Medicare drug plan for details about which specific types of insulin will be covered on their plan and at which cost-sharing.

Part D Senior Savings Model
Type NDC Model Drug Name Dosage Form
Rapid-Acting 00024-5925-05 Admelog® Pen
Rapid-Acting 00024-5924-10 Admelog® 10mL Vial
Rapid-Acting 00024-5926-05 Admelog® 3 mL Vial
Rapid-Acting 00088-2500-33 Apidra® Vial
Rapid-Acting 00088-2502-05 Apidra® SoloStar® Pen
Rapid-Acting 00169-3201-11 Fiasp® Vial
Rapid-Acting 00169-3204-15 Fiasp® FlexTouch® Pen
Rapid-Acting 00169-3205-15 Fiasp® PenFill® cartridge Pen
Rapid-Acting 00002-7510-01 Humalog® 10 mL Vial
Rapid-Acting 00002-7510-17 Humalog® 3 mL Vial
Rapid-Acting 00002-7516-59 Humalog® Cartridge Pen
Rapid-Acting 00002-7714-59 Humalog® Junior KwikPen® Pen
Rapid-Acting 00002-8799-59 Humalog® KwikPen® U-100 Pen
Rapid-Acting 73070-0100-11 Insulin Aspart Vial
Rapid-Acting 73070-0103-15 Insulin Aspart FlexPen® Pen
Rapid-Acting 73070-0102-15 Insulin Aspart PenFill® Cartridge Pen
Rapid-Acting 66733-0773-01 Insulin Lispro Vial
Rapid-Acting 00002-7752-05 Insulin Lispro Junior KwikPen®* Pen
Rapid-Acting 66733-0822-59 Insulin Lispro KwikPen® Pen
Rapid-Acting 00002-8222-59 Insulin Lispro KwikPen®* Pen
Rapid-Acting 00002-7737-01 Insulin Lispro* Vial
Rapid-Acting 00002-8207-05 Lyumjev™ Kwikpen® U-100* Pen
Rapid-Acting 00002-7728-01 Lyumjev™* Vial
Rapid-Acting 00169-7501-11 NovoLog® Vial
Rapid-Acting 00169-6339-10 NovoLog® FlexPen® Pen
Rapid-Acting 00169-3303-12 NovoLog® PenFill® Pen
Short-Acting 00002-8215-01 Humulin® R 10 mL Vial
Short-Acting 00002-8215-17 Humulin® R 3 mL Vial
Short-Acting 00169-1833-11 Novolin® R Vial
Short-Acting 00169-3003-15 Novolin® R FlexPen® Pen
Intermediate-Acting 00002-8315-01 Humulin® N 10 mL Vial
Intermediate-Acting 00002-8315-17 Humulin® N 3 mL Vial
Intermediate-Acting 00002-8805-59 Humulin® N KwikPen® Pen
Intermediate-Acting 00169-1834-11 Novolin® N Vial
Intermediate-Acting 00169-3004-15 Novolin® N FlexPen® Pen
Long-Acting 00002-7715-59 Basaglar® KwikPen® Pen
Long-Acting 00088-2220-33 Lantus® Vial
Long-Acting 00088-5021-01 Lantus® Novaplus® Vial
Long-Acting 00088-2219-05 Lantus® SoloStar® Pen
Long-Acting 00088-5020-05 Lantus® SoloStar® Novaplus® Pen
Long-Acting 00169-3687-12 Levemir® Vial
Long-Acting 00169-6438-10 Levemir® FlexTouch® Pen
Long-Acting 00169-2662-11 Tresiba® Vial
Long-Acting 00169-2660-15 Tresiba® FlexTouch® U-100 Pen
Mix 00002-7512-01 Humalog® Mix 50-50 Vial
Mix 00002-8798-59 Humalog® Mix 50-50 KwikPen® Pen
Mix 00002-7511-01 Humalog® Mix 75-25 Vial
Mix 00002-8797-59 Humalog® Mix 75-25 KwikPen® Pen
Mix 00002-8803-59 Humulin® 70/30 KwikPen® Pen
Mix 00002-8715-01 Humulin® 70-30 10 mL Vial
Mix 00002-8715-17 Humulin® 70-30 3 mL Vial
Mix 73070-0200-11 Insulin Aspart Mix 70/30 Vial
Mix 73070-0203-15 Insulin Aspart Mix 70/30 FlexPen® Pen
Mix 00002-8233-05 Insulin Lispro Protamine and Insulin Lispro KwikPen Mix75/25™* Pen
Mix 00169-1837-11 Novolin® 70/30 Vial
Mix 00169-3007-15 Novolin® 70/30 Pen
Mix 00169-3685-12 NovoLog® Mix 70/30 Vial
Mix 00169-3696-19 NovoLog® Mix 70/30 FlexPen® Pen
Concentrate 00002-7712-27 Humalog® KwikPen® U-200 Pen
Concentrate 00002-8501-01 Humulin® R U-500 Vial
Concentrate 00002-8824-27 Humulin® R U-500 KwikPen® Pen
Concentrate 00002-8228-27 Lyumjev™ Kwikpen® U-200* Pen
Concentrate 00024-5871-02 Toujeo® Max SoloStar® Pen
Concentrate 00024-5869-03 Toujeo® SoloStar® Pen
Concentrate 00169-2550-13 Tresiba® FlexTouch® U-200 Pen
Combination 00024-5761-05 Soliqua™ 100/33 Pen
Combination 00169-2911-15 Xultophy® Pen
Note: CMS will update this list based on NDC or drug changes from participating manufacturers.
*Added August 17, 2020.

The following pharmaceutical manufacturers are participating in the Part D Senior Savings Model for CY 2021:
  • Eli Lilly and Company
  • Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
  • Sanofi-Aventis U.S. LLC

Sources include:

https://www.cms.gov/newsroom/press-releases/cms-launches-groundbreaking-model-lower-out-pocket-expenses-insulin
https://www.cms.gov/newsroom/fact-sheets/part-d-senior-savings-model
https://innovation.cms.gov/files/x/partd-seniorsav-plan-rfa.pdf
https://innovation.cms.gov/innovation-models/part-d-savings-model
https://www.cms.gov/newsroom/press-releases/trump-administration-continues-keep-out-pocket-drug-costs-low-seniors
https://innovation.cms.gov/media/document/partd-seniorsav-cy21-spraddendum
https://innovation.cms.gov/media/document/partd-senior-savings-model-cy21-faqs





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