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This brief presents key facts and analysis about affordability of health care costs among people with Medicare, including younger adults with long-term disabilities, drawing on data from various sources.
This brief describes current coverage of GLP-1s in Medicare and Medicaid, the Centers for Medicare & Medicaid Services’ (CMS) efforts to expand access and lower costs for GLP-1s through temporary demonstration programs including the BALANCE Model, and potential impacts on beneficiaries and program budgets.
Under the Medicare Drug Price Negotiation Program, the federal government negotiates prices with drug companies for certain high-cost drugs covered under Medicare Part B and Part D. This brief provides information about several key aspects of the Medicare drug price negotiation program, with a focus on the 2028 implementation year.
CMS’s efforts to expand Medicare coverage of GLP-1s for obesity could provide substantial benefits to millions of Medicare beneficiaries, given the potential demand for these highly effective medications…There are potential drawbacks to the short-term program, however.
The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescription drug plans (PDPs). New data from CMS shows that 56 million people are enrolled in Part D plans as of February 2026, with more in MA-PDs than PDPs, reflecting higher overall enrollment in Medicare Advantage than in traditional Medicare. Enrollment in group MA-PD plans decreased while…
The Medicare drug price negotiation program could improve coverage of drugs selected for negotiation for Medicare beneficiaries because the law requires all Medicare Part D plans to cover each of the selected drugs, including all dosages and forms, when negotiated prices take effect. This analysis examines 2026 Medicare Part D formulary coverage of drugs selected for negotiation to measure the effect of the IRA's coverage requirement.
This brief provides an overview of the role of PBMs in managing pharmacy benefits, discusses federal efforts to reform certain PBM business practices, and explains the estimated federal budgetary impact of the recently enacted legislation, which would be a reduction in the federal deficit of $2.1 billion over 10 years, according to CBO.
Ahead of the Trump administration’s planned expansion of Medicare coverage for GLP-1s to treat obesity through temporary models and the availability of Medicare’s negotiated price for certain GLP-1 products beginning in 2027, this analysis examines CMS’s Medicare Part D claims data from 2019 to 2024 to document the increase in the number of beneficiaries being treated with GLP-1 drugs and the growth in Medicare spending and claims for these drugs.
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