Excellus BlueCross BlueShield, Central New York’s largest health insurer, announced it is introducing three new programs to reduce the out-of-pocket cost of diabetic medications for members in 2021. One in 10 adults has diabetes and the cost of medications such as insulin “continues to dramatically increase,” the health insurer said in an Oct. 20 news […]
Excellus BlueCross BlueShield, Central New York’s largest health insurer, announced it is introducing three new programs to reduce the out-of-pocket cost of diabetic medications for members in 2021.
One in 10 adults has diabetes and the cost of medications such as insulin “continues to dramatically increase,” the health insurer said in an Oct. 20 news release.
More than $1 billion a year is spent on drugs to treat diabetes in upstate New York alone.
Beginning Jan. 1, 2021, some Excellus programs will offer “significant savings” on insulin and certain diabetic medications for members enrolled in select commercial and Medicare health plans, the insurer said.
Commercial insurance and individual exchange programs
The New York State $100 insulin max program limits the out-of-pocket expense for prescription insulin medications. Members will pay no more than $100 for a 30-day supply of a covered insulin. This applies to all out-of-pocket expenses, including copayments, deductibles, and coinsurance.
Under the patient-assurance program, members will pay no more than $25 for a 30-day supply of eligible Tier 2 diabetic drugs.
Medicare Advantage direct pay
Nationally, about one in every three Medicare beneficiaries has diabetes and more than 3.3 million Medicare beneficiaries use one or more of the common forms of insulin, according to the Centers for Medicare and Medicaid Services (CMS).
Under the Part D senior savings model, to keep out-of-pocket costs “low, consistent, and predictable,” Excellus says it will lower the cost of select insulin products to a maximum copay of $30 through the deductible, initial, and coverage-gap phases on select Medicare Advantage direct-pay plans.
CMS says this program will save Medicare beneficiaries an average of $446 in annual out-of-pocket costs for select insulins, or more than 66 percent, relative to their average cost-sharing today.
“Out-of-pocket costs can fluctuate one month to the next because of the different phases in the Part D prescription drug benefit. This program provides Medicare members with a set copay for their insulin from the beginning of the plan year through the coverage gap,” Mona Chitre, chief pharmacy officer and VP of integrated clinical strategy at Excellus, said in the release.
“Ensuring a consistent co-pay for members can lead to better adherence, and taking medication as directed can result in better health outcomes.”
