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  • 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.

  • Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines

    Issue Brief

    As the U.S. prepares for nationwide distribution of vaccines to combat COVID-19, some are asking whether people who get the first of two doses will return to complete the series. This analysis draws on Medicare Part D prescription drug claims data for the herpes zoster vaccine Shingrix, which also requires two doses, to shed light on this potential challenge of the leading COVID-19 vaccine candidates.

  • Analysis Finds 14 Million Medicare Part D and Large Employer Plan Enrollees Used Mail-Order Pharmacies Pre-Pandemic, Top Drugs Filled Were to Treat Chronic Conditions

    News Release

    With questions being raised about potential delays in U.S. Postal Service delivery, a new KFF data note estimates 14 million enrollees in Medicare Part D and large employer plans relied on mail-order pharmacies for at least one prescription in 2018, with a total of over 170 million prescriptions fulfilled.

  • Mail Delays Could Affect Mail-Order Prescriptions for Millions of Medicare Part D and Large Employer Plan Enrollees

    Issue Brief

    Potential changes in mail service delivery could be a concern for people who receive prescription drugs from mail-order pharmacies. To understand who may be most affected by delays in the delivery of prescription drugs, we analyzed use of mail order in Medicare Part D and large group employer plans, and identified the therapeutic classes and specific drugs with the highest volume of fills by mail-order pharmacies in each market.

  • Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2022

    Issue Brief

    This issue brief provides an overview of the Medicare Part D prescription drug benefit market for 2022, with a primary focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income beneficiaries, and information about the national Part D drug plans available in 2022.

  • Medicare Advantage 2022 Spotlight: First Look

    Issue Brief

    For 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by nine firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 59 percent will charge no premium in addition to the monthly Medicare Part B premium. As in previous years, the vast majority of Medicare Advantage plans will offer supplemental fitness, dental, vision, and hearing benefits. In addition, virtually all will also offer telehealth benefits in 2022.

  • Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending

    Issue Brief

    Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides coverage above a catastrophic threshold for high out-of-pocket drug costs, but there is no cap on total out-of-pocket drug costs that beneficiaries pay each year. Recent legislative proposals would add a cap on out-of-pocket spending under Part D. This analysis focuses on the potential impact of different out-of-pocket spending caps in terms of how many beneficiaries would be affected and how much they could save.

  • How Would Drug Price Negotiation Affect Medicare Part D Premiums?

    Issue Brief

    Proposals to allow the federal government to negotiate prescription drug prices, such as H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, aim to lower out-of-pocket drug costs for Medicare beneficiaries and private plan enrollees and achieve savings for Medicare. This data note estimates average premium savings attributable to the negotiations provision of H.R. 3 on a per capita basis for Part D enrollees who pay premiums in dollar amounts and as a share of the base beneficiary premium, based on aggregate premium reductions and baseline premiums projected by Medicare’s actuaries through 2029.