With Medicare annual open enrollment about to close on Dec. 7, Medicare experts are discovering many insurance plans are dropping some insulin coverage in 2024.
In an informal survey of 22 Medicare plans, 10 plans are dropping at least one insulin from their formulary, according to Diane Omdahl, founder of 65 Inc., which provides Medicare enrollment guidance through fee-for-service, one-on-one consultations. Four plans are dropping four or more different insulins, she said.
If you’re banking on the $35 out-of-pocket insulin cap to continue saving money next year, you must check your plan to see if your insulin is still covered. Only if your drug plan covers your insulin will you receive the $35 cap, according to the Centers for Medicare & Medicaid Services.
“Plans have the option not to cover drugs, and that’s what’s happening,” Omdahl said. “It’s going to be tough” for people if they discover later their insulin isn’t covered and capped.
Why are insurance plans dropping insulin coverage?
It could be related to the Biden administration’s changes to Medicare coverage, experts say.
Because of the insulin cap, “we’re seeing some insurance companies responding to this change by adjusting the medications they will cover,” said Dr. Karla Robinson, medical editor at drug price comparison site GoodRx. “Some plans are choosing not to cover those insulins that come with a higher manufacturing cost or are facing production challenges.”
