Excellus BlueCross BlueShield is introducing three new programs to reduce the cost of diabetic medications for members in 2021.
One in ten adults has diabetes and the cost of medications such as insulin continues to dramatically increase. More than $1 billion a year is spent on drugs to treat diabetes in upstate New York alone.
“We recognize the connection the increasing prices of these medications can have on our members’ ability to take their medications as needed,” said Mona Chitre, PharmD, chief pharmacy officer and vice president integrated clinical strategy for Excellus BCBS. “The availability of these new programs will help our members continue to have access to high quality medications at a lower cost.”
Beginning January 1, 2021, the following Excellus BCBS programs will offer significant savings on insulin and certain diabetic medications for members enrolled in select commercial and Medicare health plans.
Commercial Insurance and Individual Exchange Programs:
- NYS $100 Insulin Max: This program limits the out-of-pocket expense for prescription insulin medications. Members will pay no more than $100 for a 30-day supply of a covered insulin. This applies to all out of pocket expenses, including copayments, deductibles and coinsurance.
- Patient Assurance Program: members will pay no more than $25 for a 30 -day supply of eligible Tier 2 diabetic drugs.
Medicare Advantage Direct Pay
Nationally, about one in every three Medicare beneficiaries has diabetes and more than 3.3 million Medicare beneficiaries use one or more of the common forms of insulin, according to the Centers for Medicare and Medicaid Services (CMS).
- Part D Senior Savings Model: To keep out-of-pocket costs low, consistent, and predictable Excellus BCBS will lower the cost of select insulin products to a maximum copay of $30 through the deductible, initial and coverage gap phases on select Medicare Advantage Direct Pay plans.
According to CMS, this program will save Medicare beneficiaries an average of $446 in annual out-of-pocket costs for select insulins, or more than 66 percent, relative to their average cost-sharing today.
“Out-of-pocket costs can fluctuate one month to the next because the of the different phases in the Part D prescription drug benefit. This program provides Medicare members with a set copay for their insulin from the beginning of the plan year through the coverage gap,” said Chitre. “Ensuring a consistent co-pay for members can lead to better adherence, and taking medication as directed can result in better health outcomes.”
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.
Karen Feigel, (585) 238-4308
Excellus BlueCross BlueShield, an independent licensee of the Blue Cross Blue Shield Association, is a nonprofit health plan with 1.5 million upstate New York members. The company's mission is to help people live healthier and more secure lives through access to high-quality, affordable health care. Its products and services include cost-saving prescription drug discounts, wellness tracking tools and access to telemedicine. With more than 3,500 employees, the company is committed to attracting and retaining a diverse workforce to foster innovation and better serve its members. It also encourages employees to engage in their communities by providing paid volunteer time off as one of many benefits. To learn more, visit ExcellusBCBS.com.