Insulin Costs in Medicare Advantage

The cost of insulin varies widely from one Medicare Advantage plan to another.  I checked out all the Medicare Advantage plans in Pima County and how they cover insulin and pills for glucose control…. and I was shocked at what I found!

One plan covers certain pills for glucose control for $0 co-pay.  These include Glumetza, Janumet, Januvia, and Tradjenta.  The other plans in town have a $40 – $45 co-pay for these pills.

Insulin costs in Medicare Advantage plans vary widely.

One plan charges a $0 co-pay for Humalin, Humalog, Novalin, and Novalog, but $40 for the pills mentioned above.

Another plan covers Novalin and Novalog for a $9 co-pay, but has a $95 co-pay for Humalin and Humalog.

And yet another plan does not even cover Novalin and Novalog, but covers Humalin and Humalog for a $10 co-pay.

Other plans charge a $40-$5o co-pay for all the drugs I have mentioned…. unless you use a “preferred pharmacy”, which (for one plan) will get you a co-pay of $34.

All of this confusion makes me think of a friend of mine in Ireland who was diagnosed with diabetes a few years ago.  She gets her insulin for free.  No cost. Nada.  Doesn’t that make sense for a drug that is required for a person to live a healthy life?  If a person does not take this medication she will end up in the hospital at a huge cost to Medicare or her Medicare Advantage plan.

Why does our stupid system make this so complicated and expensive?  Why does Medicare (which highly regulates Medicare Advantage plans) allow such variations in insulin coverage from plan to plan?

People who have received a letter saying their Medicare Advantage plan is being cancelled will need to do some serious research to find the right Medicare Advantage plan for their prescriptions.  And of course they have to check to see which plans include their doctors!

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