Costlier PDPs, Cheaper MA-PDs Opt Into Insulin Demonstration

In 2021, about half of enhanced stand-alone Prescription Drug Plans (PDPs) and a little more than a third of Medicare Advantage-Prescription Drug (MA-PD) plans will participate in a new demonstration that aims to lower diabetic seniors’ out-of-pocket costs by capping copays at $35 for a broad set of insulin products. That’s one finding from a new analysis by consulting firm Avalere Health, which also uncovered some illuminating trends regarding how plan sponsors chose to price PDPs and MA-PD plans featuring the new benefit.

Among the 310 enhanced PDPs that opted to participate in CMS’s Part D Senior Savings Model for 2021, the average enrollment-weighted premium is $57.53 — $23.46 higher than the average premium for non-participating plans, the analysis found. But an opposite scenario is playing out in the MA-PD space, where the average enrollment-weighted premium for the 1,287 participating plans is $10.36 less than the cost of non-participating plans ($22.74 versus $33.10).

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