As Congress Debates Whether to Cap Insulin Pricing, Medicare Advisor Chapter Issues State-by-State Analysis Confirming Major Inequity in Insulin Access and Costs for Medicare Beneficiaries

 Analysis finds that patients in some states pay nearly 26% of median income for their life-saving insulin

Medicare coverage options vary by state, making it even more critical to choose the right plan, as it could save patients with diabetes thousands of dollars

Chapter, the leading data-driven Medicare Advisor, has today issued a new study on the average cost of two forms of insulin, finding that the average cost of insulin varies greatly by which state one lives in, with out-of-pocket costs for Medicare beneficiaries as high as $10,689 per year, or roughly 26% of their median annual income.

“This study highlights the growing crisis for American [seniors] who have diabetes and are paying a large part of their income to access a life-saving drug,” said Cobi Blumenfeld-Gantz, co-founder and CEO of Chapter. “As Chapter’s analysis shows, capping insulin costs for Medicare beneficiaries would dramatically improve the health and financial well-being of those who rely on insulin treatment and who do not have the requisite coverage through their Medicare plan. The data also shows significant variation of insulin costs based on geography – and one’s ability to pay for their medications shouldn’t depend on where they live.”

For this analysis, Chapter’s data team examined two of the most popular insulin drugs used to treat people with diabetes and compared the annual cost of insulin for all available Medicare plans (Medicare Part D Plans and Medicare Advantage Prescription Drug plans). The team analyzed the latest prescription drug prices for 2022 in the most populous ZIP codes in each state and Washington DC and paired this data with pharmacy-specific pricing in these ZIP codes. To compare insulin prices with income, the data team used the median income in every state adjusting for households of all sizes and incomes.

A table of state-by-state analysis follows below, and the complete analysis can be found at [https://askchapter.org/magazine/senior-health-wellness/medicare-resources/state-insulin-costs]

The findings highlight three issues with current insulin pricing and coverage options across America:

• Geographic Cost Inequality: The state a person lives in plays a major factor in the average cost of insulin adjusted for median income. In Pennsylvania, the average cost of insulin makes up the highest percentage of the median income.
• Varying Access to Plans: The cost of insulin not only plays a role in the out-of-pocket costs Americans have to pay, but it also determines their coverage options when it comes to the number of plans that cover insulin. In states like Florida, with a large senior population, only 38.5% of Part D plans actually cover insulin.
• Inconsistent Coverage: The level of coverage a Medicare beneficiary receives varies greatly. A person in Connecticut could pay anywhere from $1,613 to $10,689 on insulin in one year, on average, simply because they are not on the best plan for their needs.

As Congress considers drug pricing policies to include in the Inflation Reduction Act of 2022, those provisions could significantly impact and lower prescription drug prices in America. In particular, an insulin pricing cap would have an incredible impact on the millions of Americans on Medicare living with diabetes as well as positively impact the economy.

“We encourage seniors to get the help they need to find the right Medicare plan for them because it could save them thousands of dollars each year,” said Ari Parker, Co-Founder, and Head Medicare Advisor at Chapter. “It could mean the difference between maintaining their health and putting food on their table.”

*Ranked by average cost of non-covered plans, highest to lowest*

About Chapter:

Chapter is a Medicare Advisor with a simple commitment: it’s impossible to find a better Medicare recommendation or better support anywhere else. Chapter’s team and technology search every Medicare option nationwide at an unprecedented level of detail.

Chapter’s licensed advisors provide personalized, end-to-end guidance to Americans navigating Medicare. The advisory team earns identical compensation irrespective of the selected plan or carrier, ensuring that each Chapter member receives recommendations tailored solely for their needs. Additionally, Chapter’s platform supports older Americans in deciding when and how to sign up for Medicare and whether they can improve existing coverage to get better benefits for less. Chapter also hosts hundreds of educational events every year and partners with employers, financial advisors, benefits professionals, non-profits, religious institutions, and community leaders. For more information, visit www.askchapter.org.

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