Medicaid provides health coverage for millions of Americans, including prescription drug coverage for many people with substantial health needs. This fact sheet provides an overview of Medicaid’s prescription drug benefit and recent trends in spending and utilization
Amid heightened public concern, the cost of prescription drugs is a focus of attention by the Biden administration and lawmakers in Congress and state capitals. Proposed actions range from allowing Medicare to negotiate the prices of certain drugs to limiting some drug price increases to inflation and capping out of pocket costs for Medicare beneficiaries in Part D, among other initiatives. See KFF’s research, analysis and public opinion data, as well as Kaiser Health News’ journalism, related to prescription drugs and their costs.
Featured Prescription Drugs Resources
This analysis of insurance claims data finds that Congressional proposals to set a $35 per month cap on what people pay out of pocket for insulin would provide financial relief to at least 1 out of 5 insulin users with different types of private health insurance.
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Related Prescription Drugs Resources
- Public Opinion on Prescription Drugs and Their Prices
- Insulin Costs and Coverage in Medicare Part D
- Prices Increased Faster Than Inflation for Half of all Drugs Covered by Medicare in 2020
- Dec. 8 Event: Unpacking the Prescription Drug Provisions of the Build Back Better Act
- The Public Weighs In On Medicare Drug Negotiations
- Potential Savings for Medicare Part D Enrollees Under Proposals to Add a Hard Cap on Out-of-Pocket Spending
- Medicare Part B Drugs: Cost Implications for Beneficiaries in Traditional Medicare and Medicare Advantage
- 10 FAQs on Prescription Drug Importation
- Medicaid Outpatient Prescription Drug Trends During the COVID-19 Pandemic
- Prescription Drug Rebates, Explained
- Who is most likely to have high prescription drug costs?
- Latest News on Prescription Drugs from Kaiser Health News
This chart collection examines what we know about prescription drug spending and use in the U.S. and comparably large and wealthy countries, using data from the Organization for Economic Cooperation and Development (OECD).
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In this post for The JAMA Forum, Larry Levitt examines both the Democratic candidates’ proposals and the Trump administration’s record on lowering drug prices, which remains a top issue for the public with bi-partisan support.
Annual premiums for employer-sponsored family health coverage reached $20,576 this year, up 5% from last year, with workers on average paying $6,015 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,655 for single coverage. Fifty-six percent of small ﬁrms and 99% of large ﬁrms oﬀer health beneﬁts to at least some of their workers, with an overall oﬀer rate of 57%.
KFF Health Tracking Poll – November 2019: Health Care In The 2020 Election, Medicare-for-all, And The State Of The ACA
This poll examines the issues Democrats most want to hear in the debates, their trust of the Democratic candidates on health care, attitudes towards Medicare-for-all and a public option, perceptions of the Affordable Care Act’s health insurance marketplaces, and prospects of legislation to address prescription drug costs.
States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. Report findings are drawn from the annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019 (which began for most states on July 1, 2018). Key areas covered include changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.
Health Affairs Article: Medicare Part D Plans Rarely Cover Brand-Name Drugs When Generics Are Available
In an article in Health Affairs, KFF’s Juliette Cubanski, Sarah True and Tricia Neuman, and several other co-authors, explore how often brand-name drugs receive favorable formulary inclusion relative to generics in the Medicare Part D program’s prescription drug plans.
Prescription drug spending in Medicaid and other health programs has returned to the national policy debate. This analysis examines Medicaid outpatient prescription drug utilization and spending before rebates over the 2015 to 2019 period, which is helpful for understanding recent cost drivers and areas for targeted policy action.
The brief examines the potential impact of Aduhelm, a newly approved drug for Alzheimer’s disease, on state and federal Medicaid costs and looks at potential policy actions that could limit Medicaid’s potential costs.
How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020
This report summarizes results from a Medicaid pharmacy benefit survey of all 50 states and the District of Columbia (DC) conducted by Kaiser Family Foundation and Health Management Associates in 2019.
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.