Here is important information you need to know about owning a prescription drug plan:

CHANGES TO INSULIN COSTS FROM INFLATION REDUCTION ACT

• In 2023, under a provision in the Inflation Reduction Act, Part D enrollees will pay no more than $35 per month for covered insulin products in all Part D plans. Under a Medicare Part D prescription drug plan, if an insulin is a covered insulin product, the $35

  cap for a month’s supply for each insulin product applies, as of January 1, 2023. A covered insulin product is one that is included on a Part D sponsor’s formulary. This includes any new insulin products that become available during the plan year. An insulin product might also be considered covered in other instances.

• In addition, under Medicare Part B, if insulin is delivered through a traditional pump that is covered under the durable medical equipment benefit, the cost-sharing amount for a person with Medicare is capped at $35 for a month’s supply of insulin beginning July 1, 2023.

PRESCRIPTION DRUG COVERAGE STAGES

• Annual Deductible

  — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $505 in 2023. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.

• Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2023, the initial coverage cap is $4,660. After you and the insurance company together have paid this amount, then you enter the coverage gap.

• The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 37% for generics. Your gap spending will continue until you have paid $7,400 out of your own pocket in 2019.

• Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.