We evaluated plan coverage and cost sharing for commonly used brand-name and generic drugs to estimate potential out-of-pocket spending changes for beneficiaries using the same drug and plan in both 2024 and 2025. We found that beneficiaries filling prescriptions for high-cost drugs would have expected mean savings of approximately $1,400 between 2024 and 2005.
Beneficiaries who had spending lower than the out-of-pocket cap of $2,000 would have less consistent savings as a result of plans increasing the use of coinsurance versus copayments for preferred brands and increases in premiums among some stand-alone Part D plans. The variability across plans in expected out-of-pocket spending and premiums under the redesigned drug benefit reinforces the need for Medicare beneficiaries to shop for plans that best match their expected medication use.
Stacie B Dusetzina,1 Youngmin Kwon,2 Nancy L Keating,3 Haiden A Huskamp4
- Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
- Vanderbilt University Medical Center, Nashville, Tennessee
- Harvard University and Brigham and Women's Hospital, Boston, Massachusetts.
- Harvard University, Boston, Massachusetts