Board hears Medicare updates: Part D out-of-pocket rise, insulin cap remains, and new GLP-1 bridge model

Laura Ryan, retiree benefits manager for the ERP division, presented a set of federal Medicare updates relevant to PEP and SEBB retirees. She told the board that the Medicare Part D annual true out-of-pocket maximum rose from $2,000 last year to $2,100 this year, and that the federal $35 insulin cap established in 2022 continues to apply. "So for anyone enrolled in Medicare, they won't pay more than $35 per month for an insulin drug," Ryan said.

Ryan also described a CMS short-term "bridge" demonstration for certain GLP-1 weight-loss medications beginning in July and running through Dec. 31, 2027. She said eligible Part D enrollees can access specified GLP-1 products at a $50 copay under the model and emphasized that the $50 copay for that model will not count toward a member's Part D true out-of-pocket total. Staff noted that although some parts of these federal changes fall outside the agency's direct control, they can affect members covered by state-administered plans and that HCA will continue to communicate these changes to affected members.

Board members asked about year‑to‑year premium trends and whether similar models might expand to Medicaid populations; staff said the bridge model is separate and that future expansions would have fiscal implications for states. Ryan cautioned that the transcript contained an ambiguous premium figure and that staff will circulate confirmed CMS numbers in follow-up materials rather than relying on the spoken transcript alone.