Does Medicare Part D Cover Lantus?

In this article...
  • Find out whether Medicare Part D covers Lantus Solostar, the leading brand name for insulin glargine, and discover the average costs of Lantus treatment.

Lantus Solostar is a medication that's administered via an injector pen to help manage the symptoms of Type 1 and Type 2 diabetes. Its active ingredient, insulin glargine, helps manage blood sugar levels to prevent hyperglycemia. If you require Lantus treatment and you have a Medicare Part D plan, there's a good chance it's covered in your plan. 

Does Medicare Part D Cover Lantus?

For most people, Medicare Part D covers some or all of the cost of Lantus Solostar treatment. Approximately 72% of Medicare Part D members are eligible to access the lowest cost brand-name medication copay for Lantus. As such, most people pay between $0 and $50 a month for treatment. 

Some Medicare Advantage plans might also cover Lantus treatment:

  • Medicare Advantage Prescription Drug Plans are Medicare Advantage Plans with prescription medication coverage. The majority of Medicare Advantage beneficiaries are enrolled in MA-PDs. 
  • All Medicare plans that include coverage for prescription medication come with a drug list called a formulary. You can check your individual formulary to find out if you're covered for Lantus treatment and to what extent you're covered.   

About Lantus Solostar

Lantus Solostar is administered intravenously into fatty skin located on the thigh, upper arm or belly. The site the shot is given at should be different each time for safety reasons. It's crucial that the shot isn't given in an area where skin is scarred, cut, irritated, bruised or red, and hands should be washed before and after every use. 

Correct storage of needles should be a primary safety concern for anyone using Lantus. Never reuse needles, and store all clean ones in a dedicated sharps container, which you can get from a pharmacy or make yourself using a sterile container with a lid. 

Risks Associated With Lantus

Insulin medication has a number of potential side effects, including hypoglycemia, allergic reaction, low electrolytes, runny nose, fluid retention and weight gain. Low blood sugar, or hypoglycemia, can be life threatening, so it's extra important to monitor glucose levels when using this drug.

If blood sugar levels fall below 70mg/dL, you should consume 15 grams of carbohydrates and recalculate blood glucose after 15 minutes. Signs of low blood sugar include shakiness, confusion, fatigue, hunger, rapid heart rate and sweating. 

What Tier Os Lantus Solostar?

As of 2019, the majority of Part D plans included insulin medication products such as Lantus in Tier 3. The cost of each prescription in the initial coverage phase was a little less than $50, but this increases significantly for many people. Once the coverage gap phase commences, there's an additional 25% coinsurance levy. This raises the cost of insulin therapy to over $100 per prescription in out-of-pocket costs, unless you qualify for the low income subsidy (LIS). 

LIS and Lantus

The Extra Help program for low-income Part D beneficiaries can help people earning under a certain threshold get help paying for Lantus. Income thresholds vary depending on the state you live in, and full and partial subsidies are available depending on income. Individuals who are eligible for LIS typically pay between $3 and $9 for their Lantus Solostar prescription  

What Is the Average Cost of Lantus Solostar With Medicare Part D Coverage?

Specific costs of Lantus under your Part D plan are likely to vary depending on your location and specific plan. The below table offers insight into the ranges most people can expect to pay for copays and deductibles. 

Deductible Stage

Typical Copay Stage

Deductible payments are the payments you need to make for eligible medication before Medicare coverage kicks in. During this phase, you're responsible for the full cost of treatment. 

Some Medicare Part D plans have a $0 a month deductible, and as of 2019, the deductible can't be more than $415 per month.

Once you've met your Medicare drug plan deductible, the initial coverage period commences. During the typical copay stage, you pay a coinsurance percentage or copayment flat fee for eligible prescriptions. 

As of 2019, you can typically expect to pay between $25 to $484 per month.

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