Does Medicare Cover Lantus?

Diabetes is a chronic condition brought about by blood glucose (blood sugar) that is too high. Your pancreas makes a hormone, insulin. This hormone aids in the transport of glucose from your blood to your cells and is used to generate energy.

Abnormally high levels of glucose in your blood indicate the sugar is not penetrating your cells. This situation can lead to serious health issues. 

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Medicare Benefits Solutions

Dec 17, 2021

 3 minutes read

These are the scenarios that may cause this to happen: 

  • Your pancreas stops producing insulin because your immune system obliterates the pancreas cells that normally supply it (Type 1).
  • Your body is producing insulin but not in the right amount, or your body cannot effectively use what is produced (Type 2).

Diabetes treatment

The treatment plan your doctor develops may include:

  • Lifestyle modifications, including a healthy diet and exercise program
  • Monitoring blood sugar
  • Medication or insulin therapy

Your doctor may recommend short- or long-acting insulin, depending on the stability of your blood sugar levels. Lantus is long-acting insulin (glargine), available in 100 units per milliliter. This drug is used to treat both Type 1 and Type 2 diabetes. According to the manufacturer, Sanofi, “once-daily Lantus is the most prescribed long-acting insulin.” 

Medicare benefits cover insulin and related supplies under Part B and Part D, depending on how you take insulin.

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Medicare benefits for insulin under Part B

Part B Medicare benefits cover insulin if you use an external pump. Part B durable medical equipment (DME) covers insulin pumps, blood glucose meters and continuous glucose monitor sensors. 

If you use Medicare-participating providers, your share of the cost is the Part B deductible ($203 in 2021) and coinsurance. Your coinsurance payment is 20% of the Medicare-approved amount. In some parts of the country, you must use designated pump suppliers to receive Medicare benefits. 

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Medicare benefits for insulin under Part D

Part D, your prescription drug plan, is a Medicare-approved plan you purchase from a private insurer. Generally, Part D covers injectable insulin not used with an insulin pump. If you take oral diabetes medication, your prescription drug plan may cover that as well. 

Your Part D plan may also cover these medical supplies:

  • Syringes
  • Gauze
  • Alcohol swabs
  • Disposable pumps

Costs under Part D vary with the plan. 

Resources

For Part D prescription drugs, refer to your plan’s formulary (approved list of drugs). If you have Medicare Advantage, use your plan materials as your primary resource for Medicare benefits.

Sources of information about diabetes and treatments for the disease include: 

MULTIPLAN_HCIMB40MCL_2022

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