For the first time, Part D plan patients will hit a ceiling on how much they pay out of pocket for most prescriptions
By Liz Essley Whyte, The Wall Street Journal, Jan. 15, 2024
Medicare patients lining up to fill pricey prescriptions at the pharmacy counter this year will realize some good news: For the first time, there is a ceiling on how much they will pay in 2024 for their Part D drugs.
Changes brought about by the 2022 Inflation Reduction Act mean that people on Part D plans now pay no more than roughly $3,300 on drugs annually—a number that could shift a bit based on whether they take brand or generic medications. In 2025, that cap will change again to a flat $2,000…
Here’s how it works: People who buy drugs through Medicare Part D, the government-funded insurance program that covers most prescription drugs, pay thousands of dollars for their drugs until they reach the so-called catastrophic zone of spending. After that, they had to continue paying 5% of their drugs’ cost for the rest of the year, sometimes adding up to thousands more. This year, that 5% coinsurance was eliminated. Once Medicare patients spend roughly $3,300—the “catastrophic zone” threshold for 2024—they won’t have to pay any more out of pocket for Part D drugs**.**… [end quote]
This is incredibly important for cancer patients who are taking advanced chemotherapy in pill form. These are very expensive drugs.