Medicare covers Novolog Flexpen, but the amount you pay depends on which Medicare plan you have and which pharmacy you use

Novolog (insulin aspart) Flexpen is a prefilled insulin pen used to manage type 1 and type 2 diabetes. Medicare Part D (prescription drug coverage) covers Novolog Flexpen at most pharmacies, though you will pay a copay or coinsurance. Medicare Part B also covers insulin in some cases — specifically if you use an insulin pump or are in a skilled nursing facility. For most people taking insulin by injection at home, Part D is the coverage that applies.

Your actual cost depends on three things: which Part D plan you chose, whether the pharmacy is in your plan's network, and where Novolog Flexpen sits on your plan's formulary (the list of covered drugs). Some plans cover it with a low copay; others place it in a higher tier and charge more. You can check your specific coverage by calling the number on your Medicare card or logging into your plan's website.

Key Takeaways

  • Novolog Flexpen is covered under Medicare Part D at most pharmacies, though you will owe a copay or coinsurance amount that varies by plan.
  • Your out-of-pocket cost depends on which Part D plan you have, whether you use an in-network pharmacy, and what tier the drug is placed on in that plan's formulary.
  • You can find your plan's coverage details and copay amounts by calling your plan directly or checking your plan's website with your member ID.
  • If your plan's copay is too high, you may be able to switch to a different Part D plan during the annual enrollment period, or ask your doctor about generic insulin options.

How Medicare Part D covers Novolog Flexpen

Part D is the prescription drug benefit within Medicare. It is run by private insurance companies under contract with Medicare, not by Medicare directly. Each company sets its own formulary — the list of drugs it covers — and decides what tier each drug sits on. Novolog Flexpen appears on most formularies, but not all, and the tier placement varies.

Tier placement matters because it determines your copay. A drug on Tier 1 (preferred generic) might cost $5 to $10 per fill. A drug on Tier 2 (preferred brand) might cost $35 to $50. A drug on Tier 3 (non-preferred brand) might cost $75 to $100 or more. Novolog Flexpen is a brand-name insulin, so it typically lands on Tier 2 or Tier 3, depending on the plan. Once you hit your plan's deductible (usually $505 to $560 in 2024, though this changes yearly), you start paying the copay.

Finding your plan's copay for Novolog Flexpen

The fastest way to find out what you will pay is to call the customer service number on the back of your Medicare card. Have your member ID ready. Tell them you take Novolog Flexpen and ask: What tier is it on? What is the copay? Is my pharmacy in-network? Some plans charge less at certain pharmacies, so it is worth asking which one offers the lowest price.

You can also log into your plan's website using your member ID and search for Novolog Flexpen in the formulary tool. The tool will show you the tier, copay amount, and which pharmacies are in-network. If you do not have your member ID, it is on your Medicare card or in any letter your plan has sent you.

If you use mail-order pharmacy through your plan, the copay is sometimes lower than at a retail pharmacy. Ask your plan whether mail-order is an option and what the copay would be.

What to do if your copay is too high

If your plan charges a high copay for Novolog Flexpen, you have several options. The first is to ask your doctor whether a generic insulin is appropriate for you. Insulin glargine (Lantus), insulin detemir (Levemir), and NPH insulin are all covered by Medicare Part D and are usually cheaper than Novolog because they are generic or older brand drugs. Your doctor can tell you whether switching would work for your diabetes management.

The second option is to switch to a different Part D plan. You can do this during the annual enrollment period, which runs from October 15 to December 7 each year. During this window, you can compare plans side by side and choose one with a lower copay for Novolog Flexpen. Use the Medicare Plan Finder tool at Medicare.gov to see all available plans in your area and their copays for this drug.

The third option is to ask your doctor to submit a prior authorization or formulary exception request to your plan. This is a formal request asking the plan to cover the drug at a lower tier or to cover it even if it is not on the formulary. Plans sometimes approve these requests if your doctor documents that you have tried other insulins and they did not work for you. There is no cost to request this, but it can take one to two weeks.

Medicare Part B coverage for insulin

In most cases, Part D covers your Novolog Flexpen. However, Part B covers insulin in two specific situations: if you use an insulin pump, or if you are in a skilled nursing facility (a hospital-level care facility, not a regular nursing home). If either applies to you, contact Medicare directly at 1-800-MEDICARE to understand how your coverage works, because the rules are different from Part D.

Part B insulin coverage is separate from your Part D plan and does not use the same copay structure. If you are unsure whether you may have access to for Part B coverage, ask your doctor or call Medicare. They can review your situation and tell you which part of Medicare pays for your insulin.

Using Novolog Flexpen at the pharmacy

When you fill your prescription, make sure the pharmacy knows you have Medicare Part D. Give them your member ID from your Medicare card. The pharmacy will run your prescription through your plan and tell you the copay amount at the register. If the copay is higher than you expected, ask the pharmacist to double-check that they used the correct plan and that the prescription is for the correct dose and quantity.

Novolog Flexpen comes in a box of five prefilled pens. Each pen contains 300 units of insulin. Most prescriptions are written for one box per month, though some people use more or less depending on their insulin needs. If your plan requires prior authorization or has quantity limits, the pharmacy will contact your doctor to get approval before filling.

Frequently Asked Questions

Does Medicare Part A or Part B cover Novolog Flexpen?

Part A does not cover outpatient drugs. Part B covers insulin only if you use an insulin pump or are in a skilled nursing facility. For most people taking Novolog Flexpen by injection at home, Part D is the coverage that applies.

What if my plan does not cover Novolog Flexpen at all?

Most Part D plans cover Novolog Flexpen, but a few do not. If your plan excludes it, you can request a formulary exception from your plan (ask your doctor to submit it), or you can switch to a different Part D plan during the annual enrollment period in October and November.

Can I use a GoodRx coupon or discount card instead of my Medicare coverage?

You cannot use both at the same time. If your Part D copay is higher than a GoodRx price, you can choose to pay cash and use the coupon instead, but this does not count toward your Part D deductible or out-of-pocket maximum. Ask the pharmacist to show you both prices before you decide.

Does my copay change after I reach the donut hole?

Yes. Once you and your plan have spent a combined $11,000 on drugs in 2024 (this amount changes yearly), you enter the "donut hole" or coverage gap. In the gap, you pay a higher percentage of the drug cost. Once you reach $8,850 in out-of-pocket spending, you enter catastrophic coverage and your copay drops again. Your plan will tell you when you enter each stage.

What if I cannot afford my Novolog Flexpen copay?

Novo Nordisk, the manufacturer, offers a copay information program for people with Medicare. You can find details at novolog.com or call 1-844-NOVOLOG. Some community health centers and pharmaceutical information programs also help with insulin costs. Call 211 to find programs in your area.