November 19, 2020
We’ve made a few changes to our pharmacy benefits for 2021 plans to help make medications more affordable for your patients.
Part D Senior Savings Model
The Part D Senior Savings Model is a new program recently announced by the Centers for Medicare & Medicaid Services (CMS). It caps select insulin at $35 per month for some Medicare Part D or Medicare Advantage plans. Not all carriers are participating in this program. Carriers were required to apply with CMS to participate. Premera applied and was accepted. This means insulin costs for all Premera Medicare Advantage plans is capped at $35 per month.
The new program also keeps the cost of insulin stable through all the drug cost phases for your patient.
- $35 per month during the initial deductible phase
- $35 per month during the initial coverage phase
- $35 per month during the coverage gap
On average, your patient could see a savings of $446 (66%) on insulin costs per year.
Shingrix vaccine
The Shingrix vaccine will be covered as tier one for all 2021 plans that have a pharmacy benefit. This means your patients will have only a small copay for the vaccine ($2 to $4).
But it’s important that you tell your patients to get the vaccine at an in-network pharmacy to avoid additional out-of-pocket costs. Medicare Parts A and B don’t cover the vaccine cost. It’s a Part D benefit so the provider fee for administering the vaccine isn’t covered. That cost will be billed to the patient.
Flu vaccine
As a reminder, make sure your patients get their flu shot this year. It’s more important than ever. As always, this is fully covered for our Medicare Advantage members.