Good morning,

Forwarding a few tools to help navigate insulin cost this open enrollment.

 

 

 

Mimecast Attachment Protection was unable to create safe copies of your attachments.

Thanks to Michelle in WI for providing a version of IA’s Word document in Excel to autmoatically calculate costs attached here.

 

 

Happy Medicare Open Enrollment Period (OEP) Eve everyone!

 

A few updates in advance of tomorrow related to insulin users and common questions received:

 

Resources for the step-by-step insulin comparison process

o    CMS National Training Program (NTP) 9/28 Bootcamp webinar recording step-by-step Medicare Plan Finder (MPF) process including screenshots starting at time stamp 19:57. To access the recording, log into CMS NTP site and select Webinars to access recordings. The Bootcamp slides are attached as well. The step-by-step MPF process begins on slide 25.

o    IA Drug Plan Comparison Worksheet for Clients with Insulin is attached as a Word document.

 

Common Questions

o    Can we get a list of insulins to help identify insulin users?

o    Starting 10/15/22 when a user enters an insulin medication a pop up message about $35 insulin copays will appear.  This is the most direct way to ensure insulins are flagged in MPF. See slide 33 for an example of the message in the attached 2022 NTP Medicare OEP Bootcamp Day 1 PPT slides.

o    Why can’t the $35 copayment be reflected on MPF?

o    The IRA required $35 insulin copayment for PDP or MA-PD will not be reflected on MPF this Open Enrollment Period (OEP) or in the 2023 calendar year. The is due to the statutory timing of plan bids. The annual bid process requires submission in June (before IRA passage on 8/16/22). Once approved, plans are not permitted to change the drug tiers or formulary (though drug price fluctuations will continue to impact MPF pricing). The plan bid information is used to populate MPF cost-sharing and coverage details. As a result, the MPF cannot be updated to reflect the $35 copayments for an insulin on the plan’s formulary.

o    How can insulin using beneficiaries know when they’ll exit the deductible and initial coverage phases?

o    If the plan includes a deductible, the best estimate of meeting the deductible is the MPF Plan Details Page without insulin since the $35 copayment applies in all phases, including the deductible phase.

o    The best estimate of when a beneficiary will exit the initial coverage phase is the MPF Plan Details Page with insulin products.  During the initial coverage phase the full cost of the drug counts toward reaching the $4,660.

o    Should SHIPs check for Part D Senior Savings Plans (PDSS) since they might offer insulin copayments below than $35?

o    PDSS plans will appear on MPF and reflect insulin cost-sharing at or below $35. If a beneficiary only uses insulin, a PDSS plan may offer the best cost and coverage. When making comparisons for beneficiaries with insulin and other prescription medications, then the premium, the deductible, and other coverage details must also be considered. SHIPs should follow the step-by-step process outlined in the NTP Bootcamp webinar to ensure insulin using beneficiaries obtain the best estimated costs and coverage in 2023.

While it is not critical to identify PDSS plans when following the step-by-step process, a list is available here, scroll down the page to the 2023 Part D Senior Savings Model Landscape File hyperlink.

o    What do we need to capture for Part D Enrollment Outcomes (PDEO) work?

o    Report cost change information and attach verification documentation for insulin users with insulin included on the Plan Details Page(s). While this will inflate the costs, it is the best information available on MPF at the time, and avoids the potential for miscalculations in reporting costs. Be sure to share the attached PDEO verification documentation with your teams including information about capturing insulin costs.

 

 

 

 

 

Regards,

 

Melissa Simpson (she, her, hers)
Assistant Director, Office of Healthcare Information and Counseling 
Administration for Community Living
U.S. Department of Health and Human Services
O: 202-795-7314

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