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A new legislative package signed into law by President Joe Biden on Tuesday is a big win for Medicare patients who struggle to cover the cost of insulin to manage their diabetes.

But the bill, called the Inflation Reduction Act, falls short of applying those cost controls to the broader patient population who rely on insulin.

The bill limits insulin copays to $35 per month for Medicare Part D beneficiaries starting in 2023. Notably, seniors covered by Medicare also have a $2,000 annual out-of-pocket cap on Part D prescription drugs starting in 2025. Medicare will also now have the ability to negotiate the costs of certain prescription drugs.

“We’re very excited that seniors are going to see these cost savings,” said Dr. Robert Gabbay, chief scientific and medical officer at the American Diabetes Association.

But the changes fall short of the broader applicability to diabetes patients who are covered by private insurance.

“We’re glad for the victory we have, but there’s more work to be done,” Gabbay said.

Why insulin relief was limited to Medicare patients

What Medicare beneficiaries on insulin can expect

The high costs of insulin result in 14% of patients having “catastrophic” levels of spending on the treatment, according to recent research from Yale University. For Medicare patients on insulin, catastrophic spending affects one in five patients, the research found.

Starting in 2023, the Inflation Reduction Act will cap the cost of insulin for Medicare beneficiaries at $35 per month and will include those who use insulin pumps.

Medicare beneficiaries who pay more than $35 per month after the legislation is initially enacted will be reimbursed, according to the American Diabetes Association.

For patients struggling to cover insulin, the American Diabetes Association provides resources that may help curb those costs at Insulinhelp.org.



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