![]() Part D sponsors had the opportunity to apply for CY 2023 participation by April 8, 2022. CY 2023 Participating Part D Plan Sponsors Part D Sponsor participants for CY 2022 who are looking to make formulary updates in 2022 should use the CY 2022 Model Drug List. Please note that there is a separate list of CY 2022 Model Drugs for CY 2022. Please see the list of Model drugs (PDF) for CY 2023 for more information. Mylan Specialty L.P., a Viatris Company.The following pharmaceutical manufacturers are participating in the Model for CY 2023: CY 2023 Model Participation CY 2023 Participating Pharmaceutical Manufacturers Through the Model, CMS is also testing how participating Part D sponsors may best encourage healthy behaviors and medication adherence through Part D Rewards and Incentives programs. Participating pharmaceutical manufacturers will pay the 70 percent discount in the coverage gap for the Part D insulins they market, but those manufacturer discount payments would now be calculated before the application of supplemental benefits under the Model. Under the Model, CMS is testing a change where Part D sponsors that participate in the Model offer beneficiaries prescription drug plans that provide supplemental benefits for a broad range of insulins. The Model aims to reduce Medicare expenditures while preserving or enhancing quality of care for beneficiaries. The Model does not change cost sharing in the catastrophic phase. The Model does this by offering supplemental benefits that apply after manufacturers provide a discounted price for a broad range of insulins included in the Model. Model OverviewĬMS is testing 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 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.ĭetails on pharmaceutical manufacturer and Part D sponsor Model participation can be found below. Unfortunately, sometimes the cost of insulin can be a barrier to appropriate medical management of diabetes. 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. 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.
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