Medicare Part D

This brief describes how the Medicare Part D benefit will change in 2020 under current law and proposed changes that would affect what beneficiaries, plans, manufacturers, and Medicare pay for drug costs under Part D in the future.

The analysis finds that people who switched from traditional Medicare to Medicare Advantage in 2016 had health spending in 2015 that was $1,253 less, on average, than the average spending for beneficiaries who remained in traditional Medicare (after adjusting for health risk). The findings suggest that the current payment method may systematically overestimate expected costs of Medicare Advantage enrollees. Adjusting payments to reflect Medicare Advantage enrollees’ prior use of health services could potentially lower total Medicare spending by billions of dollars over a decade.

The Medicare Part D program provides an outpatient prescription drug benefit to older adults and people with long-term disabilities in Medicare who enroll in private plans. This analysis provides the latest data about Medicare Part D coverage and costs in 2019 and trends over time, including enrollment, premiums, cost sharing, and participation in the low-income subsidy program.

The analysis examines enrollment in Medicare Advantage plans during beneficiaries’ first year on Medicare and finds that less than one-third or 29% enrolled in these private health plans, including HMOs or PPOs. The majority of people new to Medicare are choosing traditional Medicare in the year they first go on Medicare. The study looks at how these findings vary across age, Medicaid status, states, and counties.

As policymakers debate how to address the high cost of prescription drugs, a new KFF analysis compares data on prescription drug spending and use across large employer plans, Medicare Part D and Medicaid, and provides context for policy discussions about different approaches to curb rising drug costs that would affect…

Prescription drug costs are a pressing concern for both consumers and policymakers. This analysis compares prescription drug spending and use in large private employer plans, Medicare Part D, and Medicaid, based primarily on claims data by payer, which does not account for rebates.

Medicare Part D spending on insulin increased 840 percent between 2007 and 2017, far outpacing growth in the number of beneficiaries using insulin therapy, according to a new KFF analysis. The findings come at a time when the cost of prescription drugs is a major focus for policymakers in Washington,…

The price of insulin, used by people with both Type 1 and Type 2 diabetes to control blood glucose levels, has come under increasing scrutiny as policymakers grapple with rising drug costs. This data note finds spending on insulin by Medicare and beneficiaries enrolled in private Part D drug plans has increased sharply between 2007 and 2017.

This brief examines how the CMS Innovation Center (also known as CMMI) and Section 402 demonstration authority could become pathways for the Biden Administration to implement policy changes related to prescription drug costs.

A new KFF analysis finds that the list prices for most of the top Medicare Part D drugs by total spending increased as much as nine times the rate of inflation (1.7%) between 2016 and 2017, suggesting recent Congressional proposals targeting such increases could generate savings for Medicare and Part…