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Insulin Costs and Coverage in Medicare Part D

In light of heightened attention to insulin and the Trump Administration’s new Part D model to address out-of-pocket costs for insulin for Medicare beneficiaries, we analyzed out-of-pocket spending on insulin by beneficiaries enrolled in Part D drug plans, variation in Part D plan formulary coverage and tier placement of insulin products, and trends in prices for insulin.

Examining Medicare Part D Policies for Extended Supplies of Medication

Medicare Part D plan sponsors, which provide drug coverage to 45 million older adults and people with disabilities, have the option to relax their ‘refill too soon’ restrictions in response to the COVID-19 pandemic, as part of efforts to ensure adequate access to medications in disasters or emergencies. This analysis examines the share of Part D enrollees who currently have access to extended supplies of generic, brand-name, and specialty-tier drugs covered by their plan in 2020, prior to relaxation of any early-fill restrictions in response to the COVID-19 outbreak.

Quick Look: Antiretroviral Price Increases in Medicare Part D

Drug price concerns in the U.S., including for antiretrovirals, the mainstay of HIV treatment and, increasingly prevention, have prompted the introduction of several policy proposals. One proposal would require manufacturers to provide a rebate to the federal government if prices increase faster than inflation. We assessed list price changes for ARVs under Part D, which is required to cover all or substantially all ARVs.

No Itch to Switch: Few Medicare Beneficiaries Switch Plans During the Open Enrollment Period

This analysis finds that a relatively small share of people with Medicare Advantage or stand-alone Medicare Part D prescription drug coverage voluntarily switch plans during Medicare’s open enrollment period, which runs annually from Oct. 15 to Dec. 7. Shopping around among plans is important, since plans can vary significantly and change from year to year, which can have a large impact on enrollees’ coverage and costs.

A Look at Recent Proposals to Control Drug Spending by Medicare and its Beneficiaries

In response to higher drug spending growth and heightened attention to drug prices, policymakers have proposed a variety of policy initiatives to lower the cost of prescription drugs in Medicare. This brief examines in detail the range of proposals offered by the Trump Administration and members of Congress for lowering the cost of prescription drugs, their known effects on the federal budget, and their potential implications for beneficiaries and other stakeholders.