On March 11, 2020, CMS announced the release of the Part D Senior Savings Model for CY2021. This is a voluntary opt-in model, which reduces financial disincentives for plans to offer enhanced gap coverage for brand Insulin drugs, while also capping Insulin cost sharing at a $35 copay for non-LIS beneficiaries for a 30-days supply through all phases of the benefit, except for the catastrophic phase. CMS estimates that approximately 1.3 million non-LIS beneficiaries enrolled in individual Medicare Advantage (MAPD) and Part D Prescription Drug Plans (PDP) are Insulin-dependent, and most of those beneficiaries are already enrolled in an Enhanced Alternative plan. In this paper, we have outlined a number of considerations for Part D plans as they contemplate how this demonstration might impact their market and whether they should participate.
In 2019, more than 90% of Medicare Part D members were enrolled in a plan that offered the Defined Standard coinsurance for Insulin products in the coverage gap (25%), meaning that a non-low income (non-LIS) beneficiary would pay $125 for a $500 Insulin drug in this benefit phase.
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Industries
- Aviation, Aerospace & Defense
- Distribution & Wholesale
- Energy
- Surface Transportation
- Travel & Leisure
- Business Services
- Automotive
- Communications, Media, And Technology
- Education
- Energy And Natural Resources
- Financial Services
- Health And Life Sciences
- Industrial Products
- Private Equity And Principal Investors
- Public Sector And Policy
- Retail And Consumer Goods
- Transportation
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capabilities
- Business & Organization Transformation
- Corporate Finance & Restructuring
- Oliver Wyman Labs
- Sustainability Center
- Actuarial
- Climate And Sustainability
- Digital
- Lippincott: Brand and Innovation
- Oliver Wyman Engineers
- Operations
- Organizational Effectiveness
- Payments
- Pricing, Sales, And Marketing
- Risk Management
- Strategy
- Turnaround And Restructuring
- People And Organizational Performance
- Performance Transformation