What You Should Know About Medicare Part D Changes

By Kenneth Thorpe

Congress recently made a number of changes to Medicare’s “Part D” prescription drug benefit. The changes were part of President Biden’s signature legislation, the Inflation Reduction Act. The legislation was intended to make it easier for seniors to afford their medicines.

Some of the changes will indeed help seniors. But other changes could inadvertently raise seniors’ costs, reduce their access to medicines, and stifle the development of new treatments.

With open enrollment season here – it’ll run from October 15 to December 7 this year – every senior should know about the Inflation Reduction Act and how it has impacted Medicare.

First, the good news. Seniors using insulin now have their costs capped at $35 each month. This has already made a huge difference for those living with diabetes.

Starting next year, seniors’ yearly out-of-pocket Part D drug costs will be capped at $2,000. Seniors will also have the option to spread these costs out over the entire year through a new program called the “Medicare Prescription Payment Plan.” Both of these changes can help seniors who rely on multiple brand-name medicines and those on fixed incomes.

But right now, very few enrollees are aware of this new program. Medicare could do more to alert seniors to this new feature, especially since seniors interested in this benefit will need to opt in. During open enrollment season, seniors should consider contacting their Part D insurers if they’d benefit from spreading out their pharmacy costs.

Because of the Inflation Reduction Act, Medicare can now set prices on some covered drugs for the first time ever. Unfortunately, this policy has had some unintended effects on the development of new medicines. Thus far, it has already resulted in the discontinuation of at least 36 research programs and 22 experimental drugs.

The Inflation Reduction Act has also resulted in higher premiums for seniors. This year, standalone Part D plans were on track to cost 21 percent more than they did last year, on average. As a result, many seniors switched to lower cost options. The number of plans available has also dropped, down about 25 percent since 2020.

Because of the law, many insurers have also shifted some medications to “non-preferred” or “specialty” tiers that require higher out-of-pocket costs, restricting beneficiaries’ access to previously covered drugs. Some insurers have also created rules that make it harder to get the drugs your doctor recommends, like making patients first try cheaper options.

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It is important that seniors learn about these changes – and the impact they’re having on their access to medicines.

Kenneth E. Thorpe is chairman of the Department of Health Policy and Management at the Rollins School of Public Health, Emory University. He is chairman of the Partnership to Fight Chronic Disease.