Part D Senior Savings Model

The Part D Senior Savings Model is a voluntary model intended to reduce insulin costs and increase coverage for select Medicare Advantage and Part D plans. The voluntary Model began on Jan. 1, 2021, and will continue for five years, through Dec. 31, 2025. The Part D Savings Model is participating in plans in all 50 states, D.C. and Puerto Rico in 2023.

The Centers for Medicare & Medicaid Services (CMS) projects that the Part D Senior Savings Model will provide savings to over 800,000 beneficiaries who use insulin. Each beneficiary is predicted to save an average of $446 in annual out-of-pocket costs on insulin.

The Part D Senior Savings Model sets a limit of $35 for a one-month supply of insulin in three out of the four phases of Part D Coverage. The only phase that doesn’t change cost sharing by the Senior Savings Model is the catastrophic phase.

The $35 insulin limit applies at all pharmacy types, preferred and nonpreferred, even if you order from an in-person pharmacy or online.

There are specific manufacturers participating in the Part D Senior Savings Model that are covering select insulin dosages. There are three insulin types available — rapid-acting, intermediate-acting and long-acting. Refer to CMS’s 2023 Part D Senior Savings Model National Drug Code list to see what drugs are covered.

Select Medicare Advantage and Part D plans are eligible for the Part D Senior Savings Model, but it isn’t a requirement for all plans. Insurers apply to participate in the Model.

In 2022, there are 2,159 Medicare Advantage and Part D plans participating in the Part D Senior Savings Model. CMS projects over 2,500 prescription drug plans to participate in the Model in 2023.

You can apply for the Part D Senior Savings Model by signing up for a Medicare Advantage plan or a Part D plan during open enrollment. Make sure that your plan is participating in the Model before enrolling.

According to CMS, the new $35 cap may not be reflected when you compare 2023 plans on their website. CMS recommends connecting with one of their agents if you’re not certain which plan is participating in the Model.

To get a better understanding of which plans are participating in the Part D Senior Savings Model near you, refer to CMS’s 2023 Part D Senior Savings Model Landscape File.

You can also consider applying for the Extra Help Program or reach out to the American Diabetes Association to save on insulin. Extra Help is a federal program that can save you roughly $5,100 per year.

The American Diabetes Association is a nonprofit charity that provides ample resources and aid to those struggling to pay for their insulin. They advertise three main insulin manufacturers who offer immediate assistance and long-term resources.

If any of the manufacturers below supplies you with your insulin, contact them to learn about your savings options.

Editor Samantha Connell contributed to this article.