After developing Type 2 diabetes a few years ago, Julia Cogley of Overland Park couldn’t pay $700 a month for insulin on top of two other monthly medications.
Cogley said anxiety hangs overhead knowing her monthly medication costs stack up to $2,100. She doesn’t travel or go out to eat because she spends much of her disposable income on medicine.
She’s resorted to cutting cable, one of the last places she can make a change to pad her budget, to save $100 a month.
In order to get the insulin she needed, Cogley worked with doctors who gave her free samples to get by.
But that all is changing now that a federal $35 insulin cap is in effect through the Inflation Reduction Act, which took effect at the start of 2023.
“I really cried the day that I saw that this had been passed, because it is such a huge thing,” Cogley said. “That’s with me recognizing my many blessings in my life.”
Democratic U.S. Rep. Sharice Davids, whose office referred Cogley to the Post, has highlighted the high price of insulin in the past and believes the insulin cap should be extended to all diabetics beyond just Medicare recipients.
Medicare enrollees whose plans cover insulin qualify
- This includes Part D and Part B enrollees, said Ellie Turner, communications director for Davids’ office.
- The cap went into effect for enrollees of Part D, Medicare’s optional prescription drug plan, as part of the IRA on Jan. 1.
- For Part B enrollees, who are enrolled when they retire and enter Medicare coverage, the cap goes into effect in July.
A special enrollment period lasts until the end of 2023
- Medicare enrollees can add, drop or change their Part D coverage once at any point between now and Dec. 31 in order to take advantage of the $35 cap.
- The same applies for Part B enrollees once it takes effect for them in July.
- Even if a Medicare enrollee did not know about the $35 cap during open enrollment in 2022 (after the IRA law was passed but before it took effect), they can still add it to their plan this year.
People not on Medicare do not qualify
- In his State of the Union address last month, President Joe Biden called on Congress to extend the $35 insulin cap to everyone with diabetes, including those on private insurance.
- In negotiations over the IRA, Senate Republicans took the cap off the table for privately insured diabetes patients, arguing the provision violated Congressional rules for spending bills, Axios reports.
- Some prominent Republicans, including Sen. Josh Hawley of Missouri, voted to keep the insulin cap for privately insured diabetes patients in the bill, but some others in the GOP have argued the measure doesn’t address the root cause of rising insulin prices in the U.S.
- For her part, Rep. Davids said she hopes people will see how big of an impact the $35 insulin cap has on Medicare patients like Cogley in order to build momentum for to expand the cap to others.
- “Insulin hasn’t changed in 100 years and for the price to continue to be going up the way that it is — knowing how many people are impacted — I’m so glad we got the $35 cap for folks on Medicare,” Davids said.
There are additional resources for people who need help
- The Senior Health Insurance Counseling for Kansas (SHICK) offers free, confidential counseling on Medicare, Turner said.
- Access SHICK’s service via phone at (800) 860-5260.
- Davids’ most recent annual Facebook live answering Medicare open enrollment questions can be found here.
Go deeper: Insulin costs will be capped in 2023, but most people with diabetes will not benefit
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