Retirees who have been concerned about the skyrocketing costs of prescription drugs can breathe a sigh of relief starting in 2025. A new change will take place in January of that year that will cap the annual out-of-pocket drug costs for Medicare drug plan enrollees at $2,000. This new measure is projected to bring significant savings to millions of participants in Medicare drug coverage, as stated in a recent report from AARP.
Between 2025 and 2029, approximately 1.4 million Medicare Part D enrollees will see an annual savings of $1,000 or more thanks to the new out-of-pocket cap. Additionally, over 420,000 participants will experience savings of over $3,000 during that time period. The average out-of-pocket spending in 2025 is estimated to be around $1,100 for retirees who reach the cap, representing a 56% reduction from the previous amount.
These new limits on prescription drug spending stem from changes made by Congress through the 2022 Inflation Reduction Act. As part of this legislation, Medicare was also granted the authority to negotiate certain prescription drug prices. Recently, the Biden administration unveiled the prices for the first ten drugs that are part of these negotiations.
Prior to the implementation of the Inflation Reduction Act, many Medicare Part D participants were obligated to pay 5% of their prescription drug costs without any limit for costly medications, even after reaching a specific spending threshold and entering catastrophic coverage. This often resulted in out-of-pocket expenses that could exceed $10,000 per year, forcing some retirees to forego filling their prescriptions or skipping doses.
Nancy LeaMond, an executive vice president at AARP, emphasized the tangible impact of these changes on real people – parents, grandparents, friends, and neighbors. These individuals will finally find relief from the burden of high drug costs and the fear of escalating medication prices getting out of control.
Phaseout of Coinsurance
In 2024, the Inflation Reduction Act eliminated the 5% coinsurance for the catastrophic coverage phase of Medicare Part D, setting an out-of-pocket cap of approximately $3,300 for brand-name prescriptions. With the upcoming change in 2025, a $2,000 cap on out-of-pocket Part D prescription spending will be enforced, with annual adjustments to the limit. It is estimated that around 3.2 million individuals, or 8.4% of Medicare Part D enrollees, will benefit from this change in 2025. By 2029, this number is anticipated to rise to 4.1 million people, constituting 9.6% of Part D enrollees.
The 2022 legislation is already making a significant difference for Medicare beneficiaries. They are now paying no more than $35 per month for insulin and are gaining access to certain free vaccines due to the reforms that have been put into effect. These changes are aimed at alleviating the financial strain on retirees and ensuring better access to essential medications.