CareFirst BlueCross BlueShield To Cover Insulin, Diabetic Supplies at No Cost-Share for Members
Coverage will improve benefits for people living with diabetes
Baltimore, Md./Washington, D.C. – To advance its mission to provide affordable access to health coverage, CareFirst BlueCross BlueShield (CareFirst) will begin offering preferred brand insulin and diabetic supplies coverage to members at $0 out-of-pocket, prior to meeting a deductible in 2021. Non-preferred brand insulin will be capped at $50 for a one-month supply.
Beginning January 1, 2021, CareFirst will provide access to preferred brand insulin and diabetic supplies, such as glucometer test strips and insulin syringes, as a covered benefit with no member cost-sharing in plans where CareFirst sets the health benefits and manages the financial risk, referred to as “fully-insured” plans.
The cost of insulin and other prescription drugs continue to increase, creating affordability challenges for members. Medication is the largest contributor to overall spend at CareFirst, exceeding $2.5 billion annually, and the costs continue to grow at an unsustainable rate. In 2019, members in fully-insured plans paid nearly $6M in out-of-pocket costs for insulin, which averaged to approximately $119 per fill.
“As a not-for-profit healthcare company, we are committed to providing access to affordable health coverage for individuals and families throughout the communities we serve,” said CareFirst President and CEO, Brian D. Pieninck. “Removing financial barriers to care will enhance access to diabetes management tools and drugs, ultimately resulting in better health outcomes for our members. While we have taken this step to ensure our members have access to insulin and diabetic supplies, we urge policymakers to join us in taking action to lower the price of prescription drugs so that members will have access to the medication and services they need. This is one step among a series of aggressive actions that CareFirst is and will continue to take to confront a health crisis that is facing the nation.”
The insulin benefit change applies only to members in commercial fully-insured plans. Many large employers set their own health benefits and are referred to as “self-insured” plans. CareFirst will also provide its self-insured plans with an option to waive the cost of insulin to members. In addition to these upcoming benefit changes, CareFirst members currently have access to care support programs that help members living with diabetes manage their condition including a lifestyle change program for members who are pre-diabetic, disease management coaching and a virtual care program.
These proposed benefit changes for fully-insured plans are subject to the review and approval of regulatory agencies.
About CareFirst BlueCross BlueShield
In its 83rd year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit healthcare company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to 3.4 million individuals and employers in Maryland, the District of Columbia and Northern Virginia. In 2019, CareFirst invested $43 million to improve overall health, and increase the accessibility, affordability, safety and quality of healthcare throughout its market areas. To learn more about CareFirst BlueCross BlueShield, visit our website at www.carefirst.com and our transforming healthcare page at www.carefirst.com/transformation, or follow us on Facebook, Twitter, LinkedIn or Instagram.