The Inflation Reduction Act of 2022 signed into law on August 16, 2022, set a cap on insulin cost-sharing and eliminated out-of-pocket costs for adult vaccines starting January 1, 2023. The changes apply to those with Medicare Part D, which includes all CalPERS Medicare health plan members. It doesn’t apply to Basic plan members.
$35 Per Month Price Cap and No Deductibles for Insulin
Enrollees in a Medicare Part D prescription drug plan will not pay more than $35 for a month’s supply of insulin, and deductibles won’t apply to the covered insulin product.
If you get your insulin through OptumRx, you may notice your copay lowered to $35 for a month’s supply of insulin. Prescriptions through Blue Shield and Kaiser plans already have a $20 copay, so you won’t likely see any change. Other prescriptions you may take to manage diabetes are not included in the monthly $35 cap.
If you get a 60-day or 90-day supply of insulin, your costs can’t be more than $35 for a month’s supply of covered insulin. This means for a 60-day supply of your Part D-covered insulin, you’ll pay no more than $70.
And, starting July 1, 2023, the Medicare Part B deductible will no longer apply for insulin used through a traditional pump that’s covered under the durable medical equipment benefit. Any coinsurance you pay for insulin will be $35 or less for a month’s supply. For more information on these caps, visit the Medicare website.
Adult Vaccines Available at No Cost
Another aspect of the law for 2023 is certain recommended adult vaccines are now available to Medicare members at no cost, including no copay, coinsurance, or deductible.
The covered vaccines include shingles, influenza, COVID-19, and tetanus-diphtheria-whooping cough and others recommended by the Advisory Committee on Immunization Practices.
More Benefits Coming in Future Years to Improve Access and Save Money
There are several more changes in the law to be implemented (PDF) over the next six years to improve access and affordability for the Medicare population. There will be caps on certain out-of-pocket costs, limits on Part D premium increases, and most notably, Medicare’s ability to negotiate lower drug prices.
Under this program, Medicare will negotiate directly with manufactures for a set price of certain high-cost brand name Medicare Part B and Part D drugs. The first 10 drugs selected for price negotiations will be announced by this September. The negotiated drug prices will be announced by September 1, 2024, and the prices will take effect starting in 2026. The Act was written to reduce costs for certain drugs without limiting access to them.
Rest assured, we’re working closely with OptumRx and our plans to ensure members have a seamless experience and we’ll continue to monitor developments and provide you with updates.