Question: I use an insulin pump and I didn’t see the savings on my insulin like you previously discussed. Can you explain why?

Answer: Insulin is used to help your body process the glucose in your body. For most individuals this insulin is injected via a needle or more recently, a pen type injector. For some individuals this is not adequate for controlling their blood sugar levels.

These individuals may use an Insulin Pump. An Insulin Pump is a small device that delivers insulin through a catheter directly into the body.

This device allows a continuous supply of insulin to be delivered 24 hours a day and for some individuals with diabetes that is very important.

The Insulin Pump is appropriate for those individuals who require frequent adjustments and dosages to your insulin regime as well as needing to check your blood sugar levels at least four times a day. This frequency of checking your blood sugar and adjusting the amounts and types of insulin you use daily qualifies you to try an Insulin Pump to control your Diabetes more effectively.

The Insulin Pump is considered Durable Medical Equipment (DME) and therefore is covered differently that insulin delivered via a needle or injector pen.

When using an Insulin Pump, the device and the supplies are billed to Medicare Part B. Therefore, the insulin is covered by Medicare Part B as well. When the Inflation Reduction Act passed reducing the cost for insulin, it did not immediately reduce the cost for those using the Insulin Pump.

As of July 1st, those using the Insulin Pump and the insulin used to fill the device will now see that reduction in the cost of their insulin, the way others began saving this money at the beginning of 2023.

The Centers for Medicare & Medicaid Services (CMS) has announced that ALL insulins included in their formularies, at copays of $35 or less for a 30-day supply of insulin through ALL phases of Part D & Part B coverage.

In Part D, The Deductible, Initial Coverage, Coverage Gap and Catastrophic coverage will all be no more than $35 for a 30-day supply.

There are some plans that are offering copays as low as $11 for the insulin covered on their formulary.

In Part B coverage as of July 1, this same co-pay will apply regardless of when you are filling the insulin.

The Insulin cost will be no more than $35 during the Part B deductible ($226) and during the 80/20% portion of coverage.

For Medicare enrollees who have an insulin pump they were still paying hundreds per month for their insulin, but as of July 1, the savings will be coming their way.

As enrollees move through the phases of coverage, they will see a consistent pricing structure at the pharmacy for their insulins covered on the formulary.

For those on Medicare who want more information, you can research this further at the www.medicare.gov website. For those Medicare recipients who are not comfortable using a computer, you can call 1-800-MEDICARE (1-800-633-4227) to get assistance 24 hours a day, 7 days a week.

Of course, the Annual Open Enrollment Period (October 15 to December 7) is the designated time to evaluate your current coverage in comparison with all the plans available.

This is the time to be sure that your current coverage covers all your medications and to see if any other plan is offering better savings to you.

2023 is a year that is looking better and better for those with Medicare. I am so excited to work with seniors and help them benefit from the increases in income, reduction in premiums and savings in the cost of certain types of medications.

I look forward to more improvements in the coming two years. 2023 is just the beginning of the IRA savings coming to those with Medicare.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.