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2 forms found in the DOM

GET /search/medicare

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POST /about-us/prescription-drug-law

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 * Saving money with the prescription drug law


SAVING MONEY WITH THE PRESCRIPTION DRUG LAW



A new prescription drug law that went into effect January 1, 2023, will help
save money for people with Medicare. This law improves access to affordable
treatments and strengthens the Medicare program. Here’s what the law means for
you:


MORE VACCINES COVERED

People with Medicare Part D drug coverage now pay nothing out-of-pocket for even
more vaccines. Your Part D plan won't charge you a copayment or apply a
deductible for vaccines that the Advisory Committee on Immunization Practices
recommends, including the vaccines for shingles, whooping cough, and more.


LOWER COSTS FOR INSULIN

Your Medicare drug plan can't charge you more than $35 for a one-month supply of
each Part D-covered insulin, and you don’t have to pay a
deductible

Deductible
An amount you have to pay for covered services and items each year before
Medicare or your plan starts to pay.

for your insulin.  Other questions about insulin coverage?

 * If you get a 2- or 3-month supply of insulin, your costs can’t be more than
   $35 for each month’s supply of each covered insulin.
 * If you take insulin through a traditional pump that's covered under
   Medicare’s durable medical equipment benefit, that insulin is covered under
   Medicare Part B — these benefits go into effect on July 1, 2023.
 * Get more information about this new insulin benefit. 

Learn more about insulin costs. [PDF, 133 KB]


LOWER OUT-OF-POCKET DRUG COSTS

 * Starting April 1, 2023, you might pay a lower coinsurance amount for certain
   drugs and biologicals covered by Part B, if their prices have increased
   higher than the rate of inflation. The specific drugs and potential savings
   change every quarter.
 * If you have drug costs high enough to reach the catastrophic coverage phase
   in your Medicare drug coverage, you won’t have to pay a copayment or
   coinsurance, starting in 2024.
 * Extra Help affording prescription drug coverage (the Part D Low-Income
   Subsidy (LIS) program) will expand to cover more drug costs for people with
   limited resources who earn less than 150% of the federal poverty level,
   starting in 2024.
 * Your yearly Part D
   out-of-pocket costs
   
   Out-of-pocket costs
   Health or prescription drug costs that you must pay on your own because they
   aren’t covered by Medicare or other insurance.
   
   will be capped at $2,000, starting in 2025. You’ll also have the option to
   pay out-of-pocket costs in monthly amounts over the plan year, instead of
   when they happen.


MEDICARE WILL NEGOTIATE TO GET YOU LOWER DRUG PRICES

For the first time, Medicare will be able to negotiate directly with
manufacturers for the price of certain high-spending brand-name Medicare Part B
and Part D drugs that don’t have competition.

 * This year, we’ll announce the first 10 drugs selected for negotiation.
   * Negotiated prices for these first 10 drugs will be effective in 2026.
 * Medicare will select and negotiate costs for:
   * 15 Part D drugs in 2025 (effective in 2027).
   * 15 Part B and Part D drugs in 2026 (effective in 2028).
   * 20 Part B and Part D drugs in 2027 (effective in 2029).
   * 20 Part B and Part D drugs in 2028 and every year after.
 * Manufacturers that don’t follow the negotiation requirements will have to pay
   a tax, and will have to pay penalties if they don’t fulfill other
   manufacturer requirements.


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