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  • What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles

    Issue Brief

    This analysis examines early indicators of how the expiration of enhanced premium tax credits has affected effectuated enrollment levels (i.e., enrollment among people who have paid their premiums), plan selections, and out-of-pocket costs in 2026, drawing on plan selection and effectuated enrollment data from the Centers for Medicare & Medicaid Services (CMS) and state-based Marketplace (SBM) Open Enrollment reports, as well as KFF survey data and individual market enrollment estimates from Wakely Consulting Group.

  • How Many People with Employer-Sponsored Insurance Use the Drugs Slated for Medicare Price Negotiations

    Issue Brief

    Among the 167 million people with employer-sponsored insurance in 2022, 3.4 million used at least one of the first 10 drugs identified for Medicare price negotiations, according to a new analysis. The most used drug for people with employer-sponsored health insurance was Jardiance, a drug used to treat diabetes and heart failure, which was taken by more than 911,000 enrollees. The analysis uses the Merative MarketScan 2022 commercial claims to estimate the number of enrollees…

  • A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration

    Issue Brief

    This brief provides a status update on prescription drug final rules advanced by the Trump Administration in its final months related to Medicare, importation, and 340B pricing for insulin and epinephrine, and an overview of key drug pricing proposals related to Medicare and prescription drug prices generally that were voted on but not enacted in the previous Congress that may return to the forefront of health policy discussions in the coming years.

  • Skepticism Surrounding ADHD Diagnoses and Medication — The Monitor

    Feature

    This volume examines the impact of recent executive actions on federal health communication, along with concerns and stigmas surrounding ADHD diagnoses and treatments, including skepticism about pharmaceutical influence on medication promotion. It also explores distrust in food regulations following the FDA’s ban on Red Dye No. 3.

  • A Small Number of Drugs Account for a Large Share of Medicare Part D Spending

    Issue Brief

    The Inflation Reduction Act requires the federal government to negotiate the price of certain high-spending drugs covered by Medicare. This analysis provides context for understanding the potential impact of negotiating prices for a limited number of Medicare-covered drugs by identifying the 10 top-selling Part D drugs in 2021, measuring the share of total Part D drug spending accounted for by top-selling drugs that year, and examining changes in spending and use of these drugs since…

  • I am about to turn 65 and go on Medicare, and my income is $125,000. I am not married. I know that people with higher incomes are required to pay higher premiums for Medicare Part B and Part D. To avoid...

    FAQs

    If you are not yet enrolled in Medicare, you can buy health insurance coverage through the Marketplace before you turn 65, and if you have a Marketplace plan, you can choose to renew it after you turn 65. But once you turn 65 and become entitled to Medicare coverage, you cannot buy a new Marketplace plan. This is because insurers are prohibited from selling health insurance coverage that duplicates what you have under Medicare, if…

  • Probing the Power and Practices of Pharmacy Benefit Managers

    Event Date:
    Event

    Pharmacy benefit managers (PBMs) are increasingly scrutinized intermediaries in the U.S. health care system, negotiating discounts on prescription medications for health insurers and employers while collecting rebates from drugmakers. On June 14, two experts joined KFF’s The Health Wonk Shop and series moderator Larry Levitt in a 45-minute discussion about the power and practices of PBMs.