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  • Medicare Part D 2008 Data Spotlight: The Coverage Gap

    Issue Brief

    This Medicare Part D data spotlight examines the coverage gap, or “doughnut hole,” in Medicare drug plans available in 2008. Part D enrollees (other than those receiving low-income subsidies) will reach the coverage gap after they incur $2,510 in total drug costs in 2008. At that point, enrollees are required to pay 100 percent of drug costs until they qualify for catastrophic coverage. The analysis finds that in 2008, more than a quarter of stand-alone…

  • Explaining Health Care Reform: Key Changes to the Medicare Part D Drug Benefit Coverage Gap

    Issue Brief

    On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. The health reform law, as modified by the Health Care and Education Reconciliation Act of 2010 which passed the House of Representatives on March 21, 2010 and is under consideration in the Senate, makes several key changes to the Medicare Part D drug benefit to reduce Part D enrollees’ out-of-pocket liability when they reach the coverage gap, known as…

  • Allowing Medicare to Negotiate Drug Prices Is A Popular Idea But May Not Produce Substantial Savings

    News Release

    In response to rising drug costs, some policymakers and presidential candidates, including Republican Donald Trump and Democrats Hillary Clinton and Bernie Sanders, have proposed allowing Medicare to negotiate directly with pharmaceutical companies over the price of prescription drugs, in contrast to the current approach under Medicare Part D drug where private plans do the negotiating.  A version of this proposal was also included in the Obama Administration’s FY 2016 and FY 2017 budgets. While the…

  • 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.

  • 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. The use of mail-order pharmacies has been rising in recent years as patients have often been incentivized or mandated to use mail service for convenience and…

  • Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021

    Issue Brief

    This issue brief provides an overview of the Medicare Part D prescription drug benefit plan landscape for 2021, with a 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 2021.

  • Simulating the Impact of the Drug Price Negotiation Proposal in the Build Back Better Act

    Issue Brief

    The Build Back Better Act (BBBA) includes a range of health and other proposals supported by President Biden, including a proposal to allow the federal government to negotiate the price of some prescription drugs covered under Medicare Part B (administered by physicians) and Medicare Part D (retail outpatient drugs). This brief illustrates the potential scope of the drug price negotiation proposal in the BBBA. This analysis is designed to highlight the types of Medicare-covered drugs…

  • Millions of Medicare Beneficiaries Use Prescription Drugs That Could Be Subject to Price Negotiation, But Build Back Better Act Provision Exempts Many Drugs With High Federal Spending

    News Release

    Twenty drugs and dozens of insulin products used by 8.5 million Medicare beneficiaries would be subject to government drug price negotiation if the Build Back Better Act (BBBA) were enacted and fully implemented in 2022, according to a new KFF analysis. The 20 drugs include 18 drugs available to beneficiaries covered under Medicare Part D (typically drugs purchased at the pharmacy) and two drugs covered under Medicare Part B (physician-administered drugs). The list includes drugs…

  • Ending COVID-19 Emergency Declarations Will Bring an End to Flexibilities that Aided Patients, Providers, Insurers, and Public Programs in Responding to the Pandemic

    News Release

    When the federal government ends COVID-19 emergency declarations that were declared in the early days of the pandemic, it will bring to a close several changes that were enacted temporarily to enable the U.S. health care system to better deal with the crisis. A new KFF resource details a number of those flexibilities and lays out what it will mean for people, providers and federal health programs when they go away. One of the key…