Medicare News
Published October 26, 2020
Learn how this new benefit will save your clients money
The Part D Senior Savings Model is a new program recently announced by The
Centers for Medicare & Medicaid Services (CMS). The program caps select insulin at $35.00 per month for some Medicare Part D or Medicare Advantage plans. Not all carriers are participating in this program. Carriers were required to apply with CMS to participate. Premera applied and was accepted. Which means…
Insulin is capped at $35.00 per month for all of our 2021 Medicare Advantage Plans.
But there’s more you need to know. Your client will pay:
- $35.00 per month during the initial deductible phase
- $35.00 per month during the initial coverage phase
- $35.00 per month during the coverage gap
- 5 percent of the cost of the drug during the catastrophic phase
On average a savings of $446.00 (66%) on insulin costs per year.
Check out how CMS breaks this down.
As you can see, your clients’ cost for insulin will remain stable and predictable through all the phases.
How does this effect your client’s drug
spend during the coverage phases?
- The full cost of the drug will apply toward your
client’s total drug spend and copays apply toward total out of pocket
expenses in the initial coverage phase and in the donut hole coverage gap.
- The 70% discount on brand name
drugs also applies toward their total spend during the donut hole coverage
gap.
Have questions or need help?
Contact your territory
manager or email us at medicaresupport@premera.com. We want to make selling Premera Medicare Advantage easy for you.