Clover Health Brokers –

This program will offer low copayments on select insulin drugs! In CY 2022, members will pay a maximum copay of $25 at a preferred pharmacy and $35 at a non-preferred pharmacy for a one-month supply of their insulin prescription. Covered insulin prescriptions will not be subject to a deductible or any coverage gap cost increases throughout the plan year. (This program includes all tier 3 insulins covered in the formulary).

Not all Clover Health plans will be participating in the Part D Senior Savings Model AKA Insulin Savings Program. Some Clover plans designed to service Medicare beneficiaries receiving a low-income subsidy will not be participating (Summary of Benefits and Evidence of Coverage will provide plan-specific details).

Below is a list of the eligible insulin drugs in Clover’s Part D Senior Savings Model Program (Insulin Savings Program):

· BASAGLAR KWIKPEN
· FIASP FLEXTOUCH
· FIASP
· FIASP PENFILL U-100 (cartridge)
· LEVEMIR SOLUTION
· LEVEMIR FLEXTOUCH
· NOVOLIN 70/30
· NOVOLIN 70/30 FLEXPEN
· NOVOLIN N SUSP 100unit/ml
· NOVOLIN N FLEXPEN SUPN 100unit/ml
· NOVOLIN R SOLUTION 100unit/ml
· NOVOLIN R FLEXPEN SOPN 100unit/ml
· NOVOLOG FLEXPEN 100unit/ml
· NOVOLOG SOLUTION 100unit/ml
· NOVOLOG MIX 70/30
· NOVOLOG MIX FLEXPEN
· NOVOLOG PENFILL 100unit/ml (CARTRIDGE)
· SOLIQUA 100/33
· TRESIBA SOLN 100unit/ml
· TRESIBA FLEXTOUCH SOPN 100unit/ml, 200unit/ml
· XULTOPHY INJ 100/3.6

Don’t Forget!

Brokers (and beneficiaries!) can reference covered insulins on the 2022 Formulary Lookup Tool (and print formulary version) on the Clover Health website marked with an “SI” = Select Insulins