The Center for Medicare Services (CMS) is working on a new proposal that would significantly lower out-of-pocket prescription costs and enhance consumer protections in Medicare Advantage (MA) and Part D plans.
The proposed plan would update the MA and Medicare Part D rules, regarding discounts for pharmacy pricing that would reduce out-of-pocket expenses for beneficiaries. While the provisions may allow Medicare to lower out-of-pocket drug costs, CMS estimates the minor expenses connected with regulations in the proposal, will not significantly altar MA plans, supplemental benefits, or monthly premiums.
How Medicare will Lower Part D Drug Costs
Many drug plans enter partnerships with pharmacies, so they may pay less for dispensed medicines. The negotiated price, however; is frequently greater than the payment the pharmacy’s receive. Medicare is proposing a rule that would require drug plans to apply ALL discounts received from network pharmacies at the point of sale, so the benefit of the savings can be passed to the beneficiary. This would lead to lower Part D drug costs
Specifically, Medicare is proposing to redefine the negotiated price as the baseline or lowest conceivable payment to the pharmacy starting on January 1, 2023. Senior65.com will update you if these provisions move forward. The new proposal also addresses protection rules, regarding marketing and communications, application evaluation, plan quality ratings, network adequacy criteria, medical loss ratio reporting, and special requirements during disasters or public emergencies. Source
2025 Updates
Starting January 1, 2025, there’s a new $2,000 annual limit on how much you’ll pay out-of-pocket for your prescription drugs in Part D. This includes your deductibles, copays, and coinsurance. Once you hit that $2,000, you pay absolutely nothing more for covered medications for the rest of the year. The “Donut Hole” is Gone (Basically)!
Also starting January 1, 2025, you’ll have the option to join the Medicare Prescription Payment Plan. This lets you spread out your out-of-pocket drug costs (like copays and coinsurance) into monthly payments throughout the year, instead of paying it all at once at the pharmacy. For the latest version, check out our full guide on “Medicare Part D.”