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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

    News Release

    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 D drug benefit has helped make drugs more affordable for people with Medicare, the lack of a hard cap on annual out-of-pocket spending under Part…

  • Summary of Costs and Impact of the Prescription Drug Provisions in the Build Back Better Act

    News Release

    As the House-passed Build Back Better Act moves to the Senate, a new explainer from KFF summarizes the key prescription drug provisions within the broader budget reconciliation bill. These provisions would lower prescription drug costs paid by people with Medicare and private insurance and curb drug spending by the federal government and private payers. The Congressional Budget Office estimates federal budget savings from the drug pricing provisions would be $297 billion over 10 years. Although…

  • Dec. 8 Event: Unpacking the Prescription Drug Provisions of the Build Back Better Act

    Event Date:
    Event

    As the Build Back Better Act shifts from the House to the Senate, there’s considerable interest in provisions that would lower the cost of prescription drugs. The House-passed bill would allow the federal government to negotiate prices for some high-cost drugs in Medicare, and set a hard cap on out-of-pocket drug spending for Medicare Part D enrollees.  For people with Medicare and private insurance, the legislation would limit annual increases in drug prices and cap…

  • Medicare’s Coverage Decision for the New Alzheimer’s Drug and Why It Matters

    Policy Watch

    This policy watch discusses the implications of Medicare's preliminary National Coverage Determination for the new Alzheimer's drug, Aduhelm, on the 2022 Medicare Part B premium and the possibility of an adjustment based on the coverage decision. The piece also discusses the implications for Medicare spending and the connection to ongoing policy discussions around prescription drug proposals in the Build Back Better Act.

  • Why Medicare’s Aduhelm Coverage Decision Could Increase Pressure on Officials to Roll Back the Record Part B Premium Increase for 2022

    News Release

    In a new Policy Watch, KFF experts explain why Medicare’s preliminary decision to cover a new Alzheimer’s drug only for a limited group of beneficiaries is likely to intensify pressure on officials to reconsider the increase in the Medicare Part B premium for 2022. Earlier this week, CMS issued a preliminary National Coverage Determination that would limit coverage of the new drug, Aduhelm, to beneficiaries with mild cognitive impairment who participate in approved clinical trials…

  • Prices Increased Faster Than Inflation for Half of all Drugs Covered by Medicare in 2020

    Issue Brief

    Recent legislation would require drug companies to pay rebates to the federal government when annual increases in prescription drug prices for Medicare and private insurance exceed the rate of inflation. As context for understanding the possible impact of this proposal, this analysis compares price changes for drugs covered by Medicare Part B (administered by physicians) and Part D (retail prescription drugs) between 2019 and 2020 to the inflation rate over the same period.

  • 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.