Monthly Insulin Caps Estimated to Save Seniors in Part D $965 a Year in Out-of-Pocket Costs

August 16, 2022
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New study quantifies impact of monthly cost sharing caps on Part D beneficiaries

West Health commissioned a study by the actuarial firm Milliman to estimate changes in spending for insulin by various parties under several different policy proposals, including the changes proposed in the Build Back Better Act. The full methodology from Milliman's analysis is included in the report below.

Key Findings

  • Medicare Part D beneficiaries who currently pay for insulin are estimated to save $855 per year on their insulin costs alone under this legislation.
  • Overall, these Medicare Part D beneficiaries are estimated to save $965 per year in out-of-pocket costs for all their medications, including insulin.
  • Capping patient costs for insulin is estimated to have a minimal impact on Medicare Part D premiums. Premiums for all beneficiaries are estimated to increase $7.00 per year, or about 60¢ per month.
  • Under the Medicare Part D program, drug manufacturers are currently required to offer a discount to reduce the list price of drugs for patients in the coverage gap. Under this legislation, manufacturer discounts for patients who use insulin are estimated to increase by over 20%, further reducing costs for patients and taxpayers.

Monthly Insulin Caps Estimated to Save Seniors in Part D $965 a Year in Out-of-Pocket Costs

Milliman's estimates for the Medicare Part D population are based on plan year 2025 utilizing the defined standard Medicare Part D benefit. Under the Medicare Part D benefit, certain low-income beneficiaries have subsidized copayments. Milliman separately analyzed the impact of policy proposals on insulin users who do not receive these subsidized copayments as well as for all beneficiaries who use insulin, including those with subsidized copayments.

Download the Full Report