Part D Senior Savings Model

The Inflation Reduction Act caps cost-sharing for each insulin product covered under a Medicare prescription drug plan at $35 for a month’s supply, beginning January 1, 2023. Also, Part D deductibles do not apply to these covered insulin products. The Part D Senior Savings Model, which first tested a similar benefit in Model-participating plans, ended on December 31, 2023.

Note for people with Medicare: Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) if you have questions or need help understanding your options. TTY users can call 1-877-486-2048.

Through the Part D Senior Savings Model (or the “Model”), the Centers for Medicare & Medicaid Services (CMS)  tested the impact of enhanced alternative Part D plan options that offered lower out-of-pocket costs for insulin as supplemental benefits. This voluntary Model began on January 1, 2021 and concluded on December 31, 2023. The Model’s test contributes to the modernization of the Part D benefit and enhanced access to prescription drugs for Medicare beneficiaries.

Background

One in every three Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. For some of these beneficiaries, access to insulin can be a critical component of their medical management, with gaps in access increasing risk of serious complications, ranging from vision loss to kidney failure to amputation to heart attacks. Unfortunately, sometimes the cost of insulin can be a barrier to appropriate medical management of diabetes.

The Centers for Medicare & Medicaid Services (CMS) Part D Senior Savings Model (or the “Model”) was designed to provide Medicare beneficiaries with new choices of Part D plans that offer insulin at an affordable and predictable cost where a one-month supply of a broad set of plan-formulary insulins costs no more than $35 each.

Details on pharmaceutical manufacturer and Part D sponsor Model participation can be found below.

Model Overview

CMS tested a change to the Medicare Coverage Gap Discount Program (the “discount program”) to allow participating Part D sponsors, through eligible enhanced alternative Prescription Drug plans (PDPs) or Medicare Advantage Prescription Drug plans (MA-PDs), to offer a Part D benefit design that includes stable, predictable copays for select insulins (no more than $35 per prescription for the month's supply) in the deductible, initial coverage, and coverage gap phases. The Model did this by offering supplemental benefits that apply after manufacturers provide a discounted price for a broad range of insulins included in the Model. The Model did not change cost sharing in the catastrophic phase.

The Model aimed to reduce Medicare expenditures while preserving or enhancing quality of care for beneficiaries. 

Under the Model, CMS tested a change where Part D sponsors that participated in the Model offered beneficiaries prescription drug plans that provided supplemental benefits for a broad range of insulins. Participating pharmaceutical manufacturers paid the 70 percent discount in the coverage gap for the Part D insulins they marketed, but those manufacturer discount payments were calculated before the application of supplemental benefits under the Model.

Through the Model, CMS also tested how participating Part D sponsors encouraged healthy behaviors and medication adherence through Part D Rewards and Incentives programs.

CY 2023 Model Participation

CY 2023 Participating Pharmaceutical Manufacturers

The following pharmaceutical manufacturers participated in the Model for CY 2023:

  • Eli Lilly and Company
  • MannKind Corporation
  • Mylan Specialty L.P., a Viatris Company
  • Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
  • Sanofi-Aventis U.S. LLC

Please see the list of Model drugs (PDF) for CY 2023 for more information.

CY 2023 Participating Part D Plan Sponsors

More than 2,500 prescription drug plans, including both Medicare Advantage, Prescription Drug plans (MA-PDs) and standalone Prescription Drug plans (PDPs), participated in the Part D Senior Savings Model for CY 2023, which began on January 1, 2023. CMS has posted a CY 2023 list of Part D Senior Savings Model Plan Participants at a state and county level below:

The following materials are applicable for CMS-approved Part D Sponsors participating in the Part D Senior Savings Model for CY 2023.

CY 2022 Model Participation

CY 2022 Participating Pharmaceutical Manufacturers

The following pharmaceutical manufacturers participated in the Model for CY 2022:

  • Eli Lilly and Company
  • MannKind Corporation
  • Mylan Specialty L.P., a Viatris Company
  • Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
  • Sanofi-Aventis U.S. LLC

Please see the list of Model drugs (PDF) for CY 2022 for more information.

CY 2022 Participating Part D Plan Sponsors

Across the nation, 2,159 prescription drug plans, including both Medicare Advantage, Prescription Drug plans (MA-PDs) and standalone Prescription Drug plans (PDPs), participated in the Part D Senior Savings Model for CY 2022. One hundred and six (106) Part D sponsors participated in the Model for CY 2022, covering more than 17 million total enrollees (over 3 million more enrollees than CY 2021). CMS estimates that the Model’s supplemental benefits are directly available to more than 800,000 enrollees who use insulin and are enrolled in a participating plan for CY 2022. Seniors who use insulin in all 50 states, D.C., and Puerto Rico had a choice of a Part D Senior Savings Model participating plan in their area in CY 2022.

 CMS has posted a CY 2022 list of Part D Senior Savings Model Plan Participants at a state and county level below:

The following materials were applicable for CMS-approved Part D Sponsors participating in the Part D Senior Savings Model for CY 2022. 

For questions relating to the Part D Senior Savings Model, please email PartDSavingsModel@cms.hhs.gov.

CY 2023 Materials

CY 2022 Materials

Additional Information

Evaluation Reports

Latest Evaluation Report

Two Pager: At-A-Glance Report (PDF)

Prior Evaluation Reports

Two Pager: At-A-Glance Report (PDF)

Where Health Care Innovation is Happening