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Lower Insulin Prices May Finally Compensate For Non-Generic Medication

Gregory Gurbikian

Forbes Finance Council | Membership (Fee-Based)


President/CEO at Healthcare Solutions Direct, LLC, a nationwide insurance agency focused primarily on the retiree health market.

Many people, not to mention seniors, with chronic illnesses, benefit greatly from generic medications. Having to budget for a monthly supply of any medication, even with Medicare, can add up. This is especially true for those suffering from diabetes. There is no generic form of insulin, so for years, diabetes patients have been stuck spending serious dollars for their maintenance medication. In fact, insulin prices, until now, continued to rise each year. Patients pay anywhere from $300 to more than $800 per month for necessary insulin. For seniors living on a fixed income, this poses a challenge to maintaining their health.

For seniors, previous strategies to combat the high cost of insulin have typically fallen under supplementary Medicare coverage. Medicare Part D plans allow for a coverage gap on prescriptions, where you only pay a percentage of the total cost of certain drugs. For brand name prescriptions, which include insulin, patients pay 25% of the overall cost. However, 25% of $300 is still $75 per month. This is just for one medication and does not take into account other required prescriptions necessary each day. Add in other common medications, such as for blood pressure, thyroid issues, pain or even heartburn, and the costs keep rising.

Taking this into account and working to offer some relief to seniors for what they pay for maintenance medications, the White House has set an insulin cap to go into effect as of 2021. This will affect certain Medicare part D and Medicare Advantage plans. Setting a maximum price can help alleviate some of the financial hardships many seniors equate to medication costs. This insulin cap will positively impact a large number of people as over 3.3 million Medicare beneficiaries use at least one common type of insulin, the Centers for Medicare & Medicaid Services noted in the release. It is often a critical part of beneficiaries’ self-care. The cap sets a $35 copay for insulin and is estimated to save Medicare patients up to 66% per year.

This is good news for those with either type 1 or type 2 diabetes. For those suffering from type 1 diabetes, injecting insulin is part of survival. Their body cannot make enough insulin on its own to live. Their immune system is mistakenly attacking insulin-producing cells in the body. The injections keep everything running as it should to live a healthy life. With type 2 diabetes, the body’s cells get more and more resistant to insulin, though not all patients with type 2 diabetes require insulin.

Changing the cost of insulin, to support these patients, has been an uphill battle due to one simple fact: the drug’s classification. Those medications with cheaper, generic forms are classified as chemicals, but insulin, because your body makes it on its own, is classified as a biological product. This loophole has enabled drug companies to keep the formula the same over the years but raise the price without offering a low-cost alternative. Recognizing the financial strain needing insulin has had on the senior community, as well as others, has proven the first step toward effecting change. The second step has been in partnering with Medicare to set reasonable pricing standards to benefit those in need.

The easiest way to ensure you have access to the financial benefits of these changes is to work with your health insurance agent. Especially with open enrollment coming up October 15 through December 7, your Medicare agent can make sure you have the right prescription drug coverage to be eligible for the insulin price cap at the start of 2021. They will not only know exactly what coverage you will need but can guide you through the sometimes confusing process of registering for everything.

This model of making maintenance medications more affordable will hopefully continue. One day there may even be a generic form of insulin to help all those diagnosed with diabetes to care for themselves more easily. Until then, working with your insurance agent is one of the best ways to stay on top of opportunities to cut costs on your medications.

The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.

Gregory Gurbikian

President/CEO of Healthcare Solutions Direct, a nationwide insurance agency focused primarily on the retiree health market. Read Gregory Gurbikian’s full executive profile here.

About Greg Gurbikian

Gregory Gurbikian is the co-founder and President/CEO of Healthcare Solutions Direct, LLC . With over 12 years of experience in the industry, Greg is dedicated to simplifying the process for both its customers and employees.

Under his leadership and vision, Healthcare Solutions Direct, LLC has become one of the nations top agencies servicing the more than 44 million beneficiaries on Medicare. With close to 11,000 people a day turning 65, those on Medicare are projected to rise to over 79 million by 2030. Healthcare Solutions Direct, LLC is poised with cutting edge technology and training to help service the transition of those going onto Medicare from start to finish. .

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