Medicare Part D has helped to make prescription drugs more affordable for people with Medicare, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Specialty tier drugs are a particular concern for Part D enrollees in this context. This analysis draws on data from Medicare’s Plan Finder website to calculate expected annual 2019 out-of-pocket costs for 30 specialty tier drugs used to treat four health conditions—cancer, hepatitis C, multiple sclerosis, and rheumatoid arthritis.
Amid heightened public concern, the cost of prescription drugs is the focus of renewed attention by the Trump administration and lawmakers in Congress and state capitals. Proposed actions range from sweeping health care system changes to targeted initiatives that could affect Medicare, Medicaid and private insurance. 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
With increased national attention towards prescription drug costs, this poll examines the public’s experiences with prescription medicine and their views on current policy proposals brought forth by congressional lawmakers and the Trump administration, including international reference pricing, transparency in drug advertisements, and negotiations with drug companies. The survey also dives into the attitudes and experiences of adults, 65 and older – a group that is more likely to report taking prescription medication and shopped for prescription drug coverage.
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- What’s in the Administration’s 5-Part Plan for Medicare Part D and What Would it Mean for Beneficiaries and Program Savings?
- Public Opinion on Prescription Drugs and Their Prices
- What Are Recent Trends and Characteristics of Workers with High Drug Spending?
- Closing the Medicare Part D Coverage Gap: Trends, Recent Changes, and What’s Ahead
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- Searching for Savings in Medicare Drug Price Negotiations
- Retail Prescription Drugs Filled at Pharmacies per Capita
How Does Prescription Drug Spending and Use Compare Across Large Employer Plans, Medicare Part D, and Medicaid?
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.
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Medicare Part D Enrollees with Serious Health Conditions Can Face Thousands of Dollars in Out-of-Pocket Costs Annually for Specialty Drugs
Despite Medicare’s protections, Part D enrollees with serious health conditions can face thousands of dollars in annual out-of-pocket costs for expensive specialty drugs, a new KFF anaylsis finds. The analysis draws on data from Medicare’s Plan Finder website to calculate expected annual 2019 costs for more than two dozen specialty tier…
This conference report summarizes discussions at a March 2018 conference in Washington with 30 leaders from the health care community to launch Initiative 18/11, a partnership between the Society of Actuaries and KFF to address the rising cost of health care in the United States. It also lays out the next steps for the initiative.
This analysis documents average deductibles and out-of-pocket limits for 2019 Affordable Care Act marketplace plans available on Healthcare.gov on all metal tiers, including silver plans after cost-sharing reductions are applied.
KFF Health Tracking Poll – November 2018: Priorities for New Congress and the Future of the ACA and Medicaid Expansion
Fielded a week after the 2018 midterm elections, this poll examines the public’s priorities for the next Congress, measures favorability for ACA provisions including Medicaid expansion, and takes a look at knowledge of the current open enrollment period among adults ages 18-64 who purchase their own insurance or are currently uninsured. With the impending Texas v. United States lawsuit, in addition to several Trump administration policy actions aimed at different aspects of the U.S. health care system, this KFF survey also examines the public’s position on pre-existing conditions protections, prescription drug advertisements, and employer exemptions from covering birth control.
Bipartisan Majorities Support Trump Administration’s Push to Get Drug Prices in Advertisements, Even after Hearing Counter-Arguments
Only 1 in 4 Potential Marketplace Customers Know When ACA Open Enrollment Ends; 1 in 5 Say They Would Buy a Short-Term Plan A large majority of the public backs the Trump Administration’s initiative to require prescription drug advertisements to include information about prices, but fewer support other administrative actions…
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.
This issue brief provides an overview of the Medicare Part D prescription drug benefit plan landscape, with a focus on stand-alone drug plans, the largest segment of the Part D market. 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 top ten Part D plans for 2019.
This list of Frequently Asked Questions (FAQs) about Medicare Open Enrollment covers a range of topics related to Medicare enrollment, Medicare Advantage, Part D, Medigap, employer/retiree coverage, Medicaid and other low-income assistance, Medicare and the Marketplaces, and more.
This fact sheet includes the latest information and data about the Medicare Part D prescription drug benefit, including current plan information, the standard benefit parameters, low-income assistance, the latest available enrollment data, and Part D program spending and financing.