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What JoCo Medicare recipients should know about the $35 insulin cap

There’s a $35 cap on insulin for Medicare enrollees, like Overland Park resident Julia Cogley, above, who relied on free insulin samples from her doctor to avoid paying $700 a month. Photo credit Juliana Garcia.

After developing type 2 diabetes a few years ago, Overland Park’s Julia Cogley couldn’t pay the $700 a month for insulin in addition to two other monthly medications.

Cogley said the anxiety is eased knowing her monthly drug costs add up to $2,100. She doesn’t travel or go out to eat because she spends much of her disposable income on medicines.

She’s resorted to cutting the cord, one of the last places she can make budget-boosting changes, to save $100 a month.

To get the insulin she needed, Cogley worked with doctors who gave her free samples to get by.

But that’s all changing now that a $35 federal insulin limit is in effect through the Inflation Reduction Act, which took effect in early 2023.

“I really cried the day I saw this had passed, because it’s such a big thing,” Cogley said. “This is with me acknowledging my many blessings in my life.”

Democratic U.S. Representative Sharice Davids, whose office referred Cogley to the Post, highlighted the high price of insulin in the past and believes the insulin limit should be extended to all diabetics in addition to just Medicare beneficiaries.

Medicare enrollees whose plans cover insulin are eligible

  • That includes Part D and Part B enrollees, said Ellie Turner, director of communications for Davids’ office.
  • The limit went into effect for those enrolled in Part D, Medicare’s optional prescription drug plan, as part of the IRA on January 1.
  • For Part B enrollees, who are enrolled when they retire and enter Medicare coverage, the limit goes into effect in July.

A special membership period runs until the end of 2023

  • Medicare enrollees can add, remove, or change their Part D coverage once anytime between now and December 31 to take advantage of the $35 limit.
  • The same goes for Part B enrollees once it goes into effect for them in July.
  • Even if a Medicare enrollee wasn’t aware of the $35 limit during open enrollment in 2022 (after the IRA law passed but before it went into effect), they can still add it to their plan this year.

People who are not on Medicare do not qualify

  • In his State of the Union address last month, President Joe Biden called on Congress to extend the $35 insulin limit to all diabetics, including those with private insurance.
  • In the IRA negotiations, Senate Republicans took the cap off the table for privately insured diabetic patients, arguing the provision violated Congressional rules for spending bills, Axios reports.
  • Some prominent Republicans, including Senator Josh Hawley of Missouri, voted to keep the insulin limit for privately insured diabetic patients in the bill, but some others in the GOP argued that the measure doesn’t address the root cause of the increase. of insulin prices in the US
  • For his part, Rep. Davids said he hopes people see how big an impact the $35 insulin cap has on Medicare patients like Cogley in order to build momentum to expand the cap to others.
  • “Insulin hasn’t changed in 100 years and the price just keeps going up as it is — knowing how many people are affected by it — I’m so glad we got the $35 cap on people on Medicare,” Davids said.

There are additional resources for people who need help

Read more: Insulin costs will be limited in 2023, but most people with diabetes will not benefit

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