HHS Report Suggests Significant Member Cost Savings With $35 Insulin Cap

Medicare beneficiaries would have saved an average of $500 each on insulin in 2020 if the $35 price cap had been instated then, according to a press release by the US Department of Health & Human Services (HHS).

The Inflation Reduction Act includes a provision capping the cost of insulin at $35 per 1 month’s supply of the drug. The price cap went into effect for Medicare Part D beneficiaries at the turn of 2023, and on July 1, 2023, the provision will also be instated for those in Medicare Part B plans, HHS said.

If the price cap had taken effect in 2020, cost-sharing would have been reduced for 1.5 million older adults, an HHS report suggests. The estimated total savings would have been $734 million and $27 million for Part D and Part B beneficiaries, respectively.

The bulk of Medicare beneficiaries projected to see savings live in Texas (n=114,000), California (n=108,000), and Florida (n=90,000), while the highest out-of-pocket annual savings were estimated in North Dakota ($805), Iowa ($725), and South Dakota ($725), HHS said.

“Thanks to this historic law, people who get their insulin through Medicare won’t have to pay more than $35 for a month’s supply,” said HHS Secretary Xavier Becerra. “No one should have to skip or ration their insulin because they can’t afford it.”

In 2019, 37% of insulin fills under Medicare incurred cost-sharing of more than $35, and 24% of these exceeded $70 per fill.

In the same year, the national average out-of-pocket cost for insulin was $58 per fill, typically for 1 month’s supply. For individuals with private insurance or Medicare, the average cost was higher at $63 per fill.  

Reference:
New HHS report finds major saving for Americans who use insulin thanks to President Biden’s Inflation Reduction Act. News Release. US Department of Health & Human Services; January 24, 2023. Accessed January 26, 2023. https://www.hhs.gov/about/news/2023/01/24/new-hhs-report-finds-major-savings-americans-who-use-insulin-thanks-president-bidens-inflation-reduction-act.html