PCMA Statement on New Milliman Report on Insulin Coverage in Medicare Part D

(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) issued the following statement on a new Milliman report on insulin coverage in Medicare Part D.

A new report conducted by the actuarial firm Milliman, “A Summary of Insulin Coverage in Medicare Part D,” shows that insulin products are widely covered on Medicare Part D formularies.

“We support lowering insulin costs for Medicare beneficiaries. Medicare Part D plans and pharmacy benefit managers (PBMs) are currently working to achieve this important objective by offering a wide range of insulin products in the most accessible and affordable way” said PCMA President and CEO JC Scott. “In addition, PBMs are supporting widespread Part D plan participation in CMS demonstration programs that cap monthly beneficiary cost-sharing.”

Specifically, the report highlights that in 2020, 2021, and 2022, insulin coverage across the insulin types included in the analysis was available to all beneficiaries enrolled in an individual Medicare Part D plan. In 2022, approximately two out of three Part D beneficiaries typically pay $35 or less for a 30-day supply of insulin. This includes non-low income (NLI) beneficiaries enrolled in a Senior Savings Model (SSM) participating plan and low income (LI) beneficiaries whose cost-sharing is subsidized for all drugs. Since 2020, insulin has been predominantly covered on the preferred brand tier (often Tier 3) of Part D formularies.

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs). PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including: commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, Medicaid plans, and others.