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Insulin injection. Photo: Courtesy of Sweet Life/Unsplash.com
Medical Disclaimer: This article is for informational purposes only. For medical advice and diagnosis, consult your doctor.
A study published in JAMA found that the out-of-pocket (OOP) cost of insulin decreased significantly among Medicare beneficiaries not receiving low-income subsidies from 2019 to 2023 in the United States.
The percentage of beneficiaries paying $35 or less for a 30-day supply of insulin increased from 48% to 75%, with the mean OOP cost decreasing from $50.87 to $21.98 (a 55.8% relative reduction).
The study analyzed data from 3.8 million Medicare Part D beneficiaries and found that insulin costs declined nationwide, but remained highest in rural Midwest states. In 2023, the mean OOP cost for a 30-day supply ranged from $10.36 in Washington, DC, to $31.09 in Minnesota.
However, about 25% of beneficiaries still paid more than $35 for a 30-day supply in 2023, often due to non-prorated claims for quantities not matching 30-day intervals. The researchers suggest that prorating OOP costs to match the Inflation Reduction Act limit could further reduce costs.
The Inflation Reduction Act (IRA) has made significant changes to insulin affordability for Medicare beneficiaries. As of January 2023, Medicare beneficiaries pay no more than $35 per month for insulin, with no deductible applied. This cap applies to all types of insulin, including those covered under Medicare Part B for use in insulin pumps, starting July 2023.
Key Benefits:
An estimated 1.5 million Medicare beneficiaries using insulin would have saved $734 million in Part D and $27 million in Part B if these caps had been in effect in 2020, averaging $500 savings per beneficiary.
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