Diabetes drugs and supplies covered by Medicare Part D
Medicare Part D provides coverage for a range of diabetes supplies, including insulin, anti-diabetic drugs and certain medical supplies. Eligible individuals enrolled in Medicare Part D pay monthly premium and co-payments. They also must meet a yearly deductible before their prescription drugs are covered.
Diabetes drugs covered by Medicare Part D
Medicare Part D is very specific about what medications are covered for diabetes. These include anti-diabetic drugs and insulin. Anti-diabetic drugs include medications in the following four categories:
- Biguanides, such as metformin
- Alpha glucosidase inhibitors, such as Precose
- Thiazolidinediones, such as Prandin and Starlix
- Sulfonylureas, such as Glipizide and Glyburide
The list of diabetes medications allowed under Medicare Part D can change, so always check with a health care provider for the most up-to-date coverage information. Medicare Part D also covers insulin delivered in vials or pens. However, it does not cover insulin used with an infusion pump. Insulin that is taken with a pump is covered by Medicare Part B.
Diabetes supplies covered by Medicare Part D
Medicare Part D also covers the supplies necessary to take insulin by inhalation or injection. Covered supplies include syringes, needles, alcohol swabs, gauze pads, insulin pens and inhaled insulin devices. The diabetes supplies covered under Part D include only those necessary to take insulin. Supplies necessary to test blood sugar or otherwise control and monitor diabetes fall under the coverage of Medicare Part B.
How the donut hole affects the cost of diabetes drugs and supplies
The 'donut hole' is a term used to describe the gap in coverage for those who have basic Medicare Part D. Here's how it works: Covered individuals pay 100 percent of the cost of their prescription drugs until their deductible is reached. After they have met the deductible, Medicare pays 75 percent of the cost and the individual pays the other 25 percent. Once total drug costs reach $2,800, the donut hole starts. Any expenses between $2,800 and the out-of-pocket maximum of $4,550 are not covered by Medicare. Once that threshold is reached, Medicare kicks in again and covers almost the entire cost of prescription drugs until the year is over and the cycle begins anew.
This gap between the coverage limit and the maximum out-of-pocket expense was addressed in part by the Affordable Care Act, passed in 2010. Starting in 2011, individuals in the donut hole received a 50 percent discount on brand-name drugs as well as a discount on generic drugs. In 2013, those discounts will increase until 2020, at which point individuals in the donut hole will only pay 25 percent of the cost for all covered prescription drugs, up to the out-of-pocket maximum.
Individuals who fall into the donut hole might be able to obtain additional help with their prescription costs through Medicare Extra Help. Visit Medicare.gov or call your Medicare Part D insurance provider to determine what options are available.