The Cost of Insulin is Soaring

The Cost of Insulin

The cost of prescription medications is rising according to NPR and many other institutions that have documented the phenomenon. The price of insulin had doubled between 2012 and 2016, and it has continued to trend upwards.

What is Insulin?

Insulin is a hormone that is produced in the body by your pancreas. This important hormone allows your body to utilize the glucose from carbohydrates as fuel. The cells in your body depend on sugar to function. Contrary to what many people believe nowadays, carbohydrates (glucose) are very essential to all functions in the body, when you eat a low-carb diet, you’re simply invoking a process called gluconeogenesis to convert—in layman’s terms, non-carbohydrates based energy sources such as fats and proteins into glycogen.

Type 1 diabetics are in most cases born, not made. At an early age, their body fails to produce enough insulin to meet demand and as such, they must supplement with insulin to keep their blood sugar levels even.

Type 2 diabetics are a result of what’s known as insulin sensitivity. IS occurs when the body produces enough insulin, but the cells are not adequately responding to it. This means that more insulin than usual is required to achieve adequate blood sugar levels.

Prevalence of Diabetes in The Elderly

Diabetes is highly prevalent among the senior citizen group. According to the ABA (American Diabetes Association), of those who are aged 65 and older, 25.2% of Seniors have some type of diabetic condition. That amounts to 12 million seniors who require diabetes-related assistance such as insulin or continual bloodwork to measure blood sugar levels.

Diabetes Coverage Under Medicare Part D

Diabetes is a condition that demands a great deal of medical attention before the patient gets the hang of managing it. Even after being able to understand what the condition requires of you and manage it effectively without much help, the requirement of pharmaceutical insulin and related supplies depending on which type of diabetes you have can be costly.

Medicare Part D covers supplies that are used to administer insulin such as syringes, needles, gauze, swabs, etc. Most importantly, Medicare Part D also covers “anti-diabetic drugs used for maintaining blood sugar”. In other words, Medicare Part D will cover insulin and other anti-diabetic drugs that are often used in conjunction with controlling blood sugar levels.

EGWP Retiree Group Medical Benefits

With prescription drugs such as insulin costing a fortune on the market, it’s more important than ever that the post-65 retirement group have access to the lowest premiums and best prescription drug coverage possible. Our retiree prescription drug plans are EGWP (Employee Group Waiver Plans), which are a newer model established for groups that are covered under Medicare Part D.

The older model is RDS (Retiree Drug Subsidy). EGWP plans tend to offer better premiums as they are calculated based on a risk formula as opposed to a flat structure based on income—which does not tell the full story for what is an adequate amount to be paying.

The RDS was once the defacto choice for many employers or institutions looking to implement a prescription drug policy for workers. The ACA revoked the tax-exempt status that this plan offered, thus making it a far less appealing choice.

We are happy to say that Benistar provides robust and affordable EGWP plans that allow for nationwide plan availability, flexibility in the plan design, flat co-pays/coinsurance, and many more things! Contact us today if you have any questions about our prescription benefits or benefits administration.