Medicare Part D

August 11 Web Event: Understanding the Health Care Provisions in the Inflation Reduction Act

The House is expected to take up the Senate-passed Inflation Reduction Act later this week, a sweeping bill that includes several landmark health care provisions that would lower prescription drug costs for people with Medicare, reduce Medicare drug spending and extend enhanced subsidies for Affordable Care Act marketplace coverage. At Noon Eastern time on Thursday,…More

Findings from 2022 Medicare and Social Security Trustees Report

Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds came out with their annual report on the state of Social Security and Medicare. First a few takeaways on the Medicare side. Overview of Medicare Part A and B Finances The Hospital Insurance (HI) Trust Fund, or Medicare Part …

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Financial hardship to afford prescription drugs over time: Evidence from 1998-2021

In the past, seniors in Medicare had to pay for all their prescription drugs out-of-pocket. For elderly individuals with multiple medical conditions, this lack of coverage was highly burdensome. To address this issue, in 2006, Medicare Part D began which provided some coverage for prescription drugs. To keep the cost of Part D down, however, …

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Preferred Pharmacies in Medicare Part D

Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does this work? A paper by Xu et al. (2022) aims to answer this question using 2011-2016 data. that compares Low Income Subsidy (LIS) Medicare beneficiaries and non-LIS beneficiaries. LIS beneficiaries …

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State Profiles Highlight Variations in How Many Low-Income Medicare Beneficiaries Get Additional Help with Their Medicare Costs

Medicare beneficiaries with low incomes and modest assets can qualify for additional financial help with Medicare premiums and cost sharing through both the Medicare Savings Programs and Medicare’s Part D Low-Income Subsidy for prescription drug coverage. A new analysis and collection of interactive profiles highlight variations across states in the number and characteristics of beneficiaries…More

Help with Medicare Premium and Cost-Sharing Assistance Varies by State

This data note provides an overview of programs that help beneficiaries with most incomes with their Medicare costs, including the Medicare Savings Programs (which provide assistance with Medicare Part A and Part B premiums and/or cost sharing) and the Part D Low-Income Subsidy (LIS) (which helps with Medicare Part D drug plan premiums and cost …

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Ending COVID-19 Emergency Declarations Will Bring an End to Flexibilities that Aided Patients, Providers, Insurers, and Public Programs in Responding to the Pandemic

When the federal government ends COVID-19 emergency declarations that were declared in the early days of the pandemic, it will bring to a close several changes that were enacted temporarily to enable the U.S. health care system to better deal with the crisis. A new KFF resource details a number of those flexibilities and lays…More

What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access

With more than two years having passed since the COVID-19 pandemic began in early 2020, questions are being raised about when to end the public health emergency declarations made by the federal government early on. This brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made, summarizes the flexibilities …

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What happened after the implementation of Medicare Part D coverage gap reform?

Since its inception in 2006, Medicare Part D beneficiaries had to contend with the dreaded “doughnut hole”. The “doughnut hole” is a coverage gap during which patients were required to pay 100% of treatment cost. To help defray some of these costs, the Patient Protection and Affordable Care Act (ACA) implemented provisions to reduce the …

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Prices Increased Faster Than Inflation for Half of all Drugs Covered by Medicare in 2020

Recent legislation would require drug companies to pay rebates to the federal government when annual increases in prescription drug prices for Medicare and private insurance exceed the rate of inflation. As context for understanding the possible impact of this proposal, this analysis compares price changes for drugs covered by Medicare Part B (administered by physicians) …

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Simulating the Impact of the Drug Price Negotiation Proposal in the Build Back Better Act

The Build Back Better Act (BBBA) includes a range of health and other proposals supported by President Biden, including a proposal to allow the federal government to negotiate the price of some prescription drugs covered under Medicare Part B (administered by physicians) and Medicare Part D (retail outpatient drugs). This brief illustrates the potential scope …

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Summary of Costs and Impact of the Prescription Drug Provisions in the Build Back Better Act

As the House-passed Build Back Better Act moves to the Senate, a new explainer from KFF summarizes the key prescription drug provisions within the broader budget reconciliation bill. These provisions would lower prescription drug costs paid by people with Medicare and private insurance and curb drug spending by the federal government and private payers. The…More

Explaining the Prescription Drug Provisions in the Build Back Better Act

The Build Back Better Act includes several provisions that would lower prescription drug costs for people with Medicare and private insurance and reduce drug spending by the federal government and private payers. This brief summarizes these provisions and discusses the expected effects on people, program spending, and drug prices and innovation.

A Record 3,834 Medicare Advantage Plans Will be Available in 2022, Up 8 Percent From 2021, While the Number of Medicare Part D Stand-Alone Plans is Decreasing Mainly Due to Firm Consolidations

A record 3,834 Medicare Advantage plans will be available across the country as alternatives to traditional Medicare for 2022, a new KFF analysis finds. That’s an increase of 8 percent from 2021, and the largest number of plans available in more than a decade. At the same time, the number of Medicare Part D stand-alone…More

Medicare Advantage 2022 Spotlight: First Look

For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by nine firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 59 percent will charge no premium in addition to the monthly Medicare …

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Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2022

This issue brief provides an overview of the Medicare Part D prescription drug benefit market for 2022, with a primary focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans …

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Potential Costs and Impact of Health Provisions in the Build Back Better Act

A summary of 10 of the major health coverage and financing provisions of the original Build Back Better Act, with discussion of the potential implications for people and the federal budget.

Part D Senior Savings Model: What is it?

If you are on Medicare, how much will you pay for insulin? The answer is in the graph below (via MedPAC’s Payment Basics) Seem confusing? Well it is. Medicare Part D beneficiaries have a deductible, then the standard coverage phase with 25% cost sharing, then a coverage gap where beneficiaries pay 25% of cost (manufacturers …

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Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending

Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides coverage above a catastrophic threshold for high out-of-pocket drug costs, but there is no cap on total out-of-pocket drug costs that beneficiaries pay each year. Recent legislative proposals would add a cap on out-of-pocket spending under Part D. This analysis focuses on the …

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How Would Drug Price Negotiation Affect Medicare Part D Premiums?

Proposals to allow the federal government to negotiate prescription drug prices, such as H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, aim to lower out-of-pocket drug costs for Medicare beneficiaries and private plan enrollees and achieve savings for Medicare. This data note estimates average premium savings attributable to the negotiations provision of …

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Medicare vaccine coverage (including how the COVID-19 vaccines are covered)

How does Medicare cover vaccines? Are the paid for by Medicare Part B or Part D? MedPAC’s June 2021 report provides a nice overview. Medicare covers vaccines under Part B and Part D. Part B covers vaccines for influenza, pneumococcal disease, hepatitis B (for patients at high or intermediate risk), and coronavirus disease 2019 (COVID-19), …

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Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Costs High Enough to Exceed the Catastrophic Threshold Over Time

Nearly 3 million Medicare Part D enrollees had out-of-pocket drug spending above the catastrophic threshold in a recent five-year period, finds a new KFF analysis that takes a comprehensive look at how many people on Medicare have drug expenses high enough to push them above that limit. While the Part D drug benefit has helped…More

What’s the Latest on Medicare Drug Price Negotiations?

In response to prescription drug spending growth and heightened attention to drug prices, some policymakers have proposed allowing the federal government to negotiate the price of prescription drugs for Medicare and private payers. This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal …

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Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time

Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries have to pay out of pocket each year. Policymakers on both sides of the aisle support proposals to modify the design of the Part D …

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time Read More »

Do most Medicare Part D drugs have CEA studies?

That is the question that a recent study by Tisdale et al. (2021) aim to answer. They first look at the top 250 Medicare Part D drugs in terms 2016 total spending based on the 2016 Medicare Part D Prescriber Public Use File. Drug characteristics were identified from the 2016 FDA Orange Book. The authors …

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GAO report on prescription drug advertising

Medicare beneficiaries are largely elderly individuals, many of whom suffer from a variety of health conditions. Pharmaceutical manufacturers want these patients and their physicians to be aware of new medical treatments that become available (i.e., new approvals) as well as new uses for existing drugs (i.e., new FDA indications). Direct-to-consumer advertising (DTCA) is one way …

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Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2021

The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans, including stand-alone drug plans and Medicare Advantage drug plans. This analysis provides the latest data about Part D enrollment, premiums, and cost sharing in 2021 and trends over time.

Analysis Finds That a Relatively Small Number of Drugs Account for the Majority of Medicare Prescription Drug Spending

A new KFF analysis finds that a relatively small share of drugs, mainly those without generic or biosimilar competitors, accounted for a disproportionate share of prescription drug spending in Medicare in 2019. This finding suggests that recent proposals that focus on prices for a limited number of high-cost drugs could achieve significant savings. The 250…More

Relatively Few Drugs Account for a Large Share of Medicare Prescription Drug Spending

As policymakers focus attention on proposals to lower prescription drug costs by allowing price negotiation or international reference pricing for a limited number of drugs, this analysis measures the share of total Medicare Part D and Part B prescription drug spending accounted for by top-selling drugs covered under each part.

How much does the U.S. federal government pay for pharmaceuticals?

A number of different federal agencies buy prescription drugs. However, the price at which these pharmaceuticals are purchased varies dramatically. To quantify this variation, a 2021 report from the Congressional Budget Office examines the following prices: Medicare Part D: the prescription drug program for Medicare beneficiaries. Prices are set when private insurers (or pharmacy benefit …

How much does the U.S. federal government pay for pharmaceuticals? Read More »

A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration

This brief provides a status update on prescription drug final rules advanced by the Trump Administration in its final months related to Medicare, importation, and 340B pricing for insulin and epinephrine, and an overview of key drug pricing proposals related to Medicare and prescription drug prices generally that were voted on but not enacted in …

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Medicare Part D: Do beneficiaries shop for high-value plans?

Medicare Part D covers prescription drugs for largely elderly Americans in the U.S. Those who qualify for both Medicare and Medicaid receive Part D drug coverage with no premiums and reduced copayments through the low-income subsidy program (LIS). Although federal and state government pays for about 6 out of every 7 dollars of the Part …

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Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines

As the U.S. prepares for nationwide distribution of vaccines to combat COVID-19, some are asking whether people who get the first of two doses will return to complete the series in order to be fully immunized. This analysis draws on Medicare Part D prescription drug claims data for the herpes zoster vaccine Shingrix, which also …

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Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond

Medicare provides significant health and financial protections to more than 60 million Americans, but there are gaps in coverage and high cost-sharing requirements that can make health care difficult to afford. This report analyzes several policy options that could help make health care more affordable for people covered by Medicare: adding an out-of-pocket limit to …

Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond Read More »

Medicare Advantage 2021 Spotlight: First Look

For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by eight firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 54 percent will charge no premium in addition to the monthly Medicare …

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Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021

This issue brief provides an overview of the Medicare Part D prescription drug benefit plan landscape for 2021, with a focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans …

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More Than Half of All People on Medicare Do Not Compare Their Coverage Options Annually

This analysis shows that more than half of Medicare beneficiaries do not compare coverage options annually during the open enrollment period, despite the fact that Medicare Advantage and Part D plans often change from one year to the next, which could lead to unexpected and avoidable costs for beneficiaries who do not review their options …

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Walmart to Offer Medicare Insurance Plans During 2020 Open Enrollment

What You Should Know: – Walmart announced it will begin selling Medicare insurance plans during this year’s annual enrollment period, Oct. 15 through Dec. 7. Today, Walmart announced the launch of Walmart Insurance Services, LLC, a licensed insurance brokerage, which will assist people with enrolling in insurance plans—and simplify what’s historically been a cumbersome, confusing …

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