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Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Costs High Enough to Exceed the Catastrophic Threshold Over Time

Nearly 3 million Medicare Part D enrollees had out-of-pocket drug spending above the catastrophic threshold in a recent five-year period, finds a new KFF analysis that takes a comprehensive look at how many people on Medicare have drug expenses high enough to push them above that limit. While the Part…

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What’s the Latest on Medicare Drug Price Negotiations?

In response to prescription drug spending growth and heightened attention to drug prices, some policymakers have proposed allowing the federal government to negotiate the price of prescription drugs for Medicare and private payers. This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal government the authority to negotiate drug prices in Medicare, describes the negotiation provisions in key legislation (H.R. 3), and discusses the potential spending effects for the federal government, beneficiaries, and private payers.

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Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time

Medicare Part D, the outpatient prescription drug benefit for Medicare beneficiaries, provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries have to pay out of pocket each year. Policymakers on both sides of the aisle support proposals to modify the design of the Part D benefit and establish a hard cap on out-of-pocket prescription drug spending by Part D enrollees. This analysis shows the number of Part D enrollees without low-income subsidies who have exceeded the catastrophic coverage threshold annually, and over multiple years, based on 2007-2019 Part D claims data.

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Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2021

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, including stand-alone drug plans and Medicare Advantage drug plans. This analysis provides the latest data about Part D enrollment, premiums, and cost sharing in 2021 and trends over time.

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Analysis Finds That a Relatively Small Number of Drugs Account for the Majority of Medicare Prescription Drug Spending

A new KFF analysis finds that a relatively small share of drugs, mainly those without generic or biosimilar competitors, accounted for a disproportionate share of prescription drug spending in Medicare in 2019. This finding suggests that recent proposals that focus on prices for a limited number of high-cost drugs could…

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Relatively Few Drugs Account for a Large Share of Medicare Prescription Drug Spending

As policymakers focus attention on proposals to lower prescription drug costs by allowing price negotiation or international reference pricing for a limited number of drugs, this analysis measures the share of total Medicare Part D and Part B prescription drug spending accounted for by top-selling drugs covered under each part.

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Moving the Needle on Prescription Drug Costs: Using the Innovation Center and Other Demonstration Authority

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.

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A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration

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.

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Price Increases Continue to Outpace Inflation for Many Medicare Part D Drugs

As context for understanding the rationale for efforts to limit drug price increases, this analysis compares changes in list prices for drugs covered by Medicare Part D in 2019 to the inflation rate, based on data from the most recent Medicare Part D drug spending dashboard from the Centers for Medicare & Medicaid Services (CMS).

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

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.

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