Part D Prescription Drug Changes in 2025

The effects on prescription drug coverage addressed in the Inflation Reduction Act is intended to deliver lower prescription drug costs, making health care more affordable. This law helps Medicare enrollees, seniors, and people with disabilities on Medicare to benefit from a $35/month cap on the cost of each Medicare-covered insulin product, as well as making certain adult vaccines available for fee.

For the first time in history this law will allow Medicare to negotiate directly with drug manufacturers to lower the price of SOME of the costliest drugs. As of January 2024, patients with high prescription drugs costs are no longer required to pay out-of-pocket costs once they reach a certain level of spending (known as the “catastrophic phase” of Medicare Part D). In January 2025, the out-of-pocket costs will be lowered even more, with a $2,000 annual cap on those costs in Medicare Part D.

All Medicare prescription drug plans (Medicare Part D plans) including both standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage will offer enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly installment payments instead of all at once at the pharmacy. Stay tuned for more information coming soon.

If you have questions as to how The Inflation Reduction Act and the new changes will affect you, please click here to contact us or call our office at 260-483-2305.

Key Part D Changes in 2025

The out-of-pocket payment structure for Part D is changing for 2025.

1. Annual Deductible: Beneficiaries will pay 100% of their prescription costs until they reach a deductible of $590.
2. Initial Coverage: After meeting the deductible, they will pay 25% of their drug costs until their out-of-pocket spending hits $2,000.
3. Catastrophic Coverage: Once the $2,000 threshold is reached, beneficiaries will pay nothing for their covered drugs for the remainder of the year.

* One major change is there will no longer be “The Donut Hole”.

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