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Prescription Drugs

The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation

The Inflation Reduction Act, which requires the federal government to negotiate the price of some drugs in Medicare, also requires all Part D plans to cover each of the drugs selected for price negotiation when negotiated prices take effect.

Recent Trends in GLP-1 Use and Spending in Medicare

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

What to Know About Pharmacy Benefit Managers (PBMs) and Federal Efforts at Regulation

President Trump Proposes Codifying MFN Drug Pricing Deals But Key Details Are Missing

New & Noteworthy
Examining the Potential Impact of Medicare’s New WISeR Model

A federal initiative to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model, is likely to have only modest impact in its first year.

State Profiles for Dual-Eligible Individuals

This data collection draws on Medicare and Medicaid administrative data to present national and state-level information on people who are covered by both Medicare and Medicaid, referred to as dual-eligible individuals (also known as dually-enrolled beneficiaries).

Medicare Advantage

Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, up from 49.8 million in 2023. They fully or partially denied 4.1 million, or 7.7%, of the prior authorization requests they received. Just 11.5% of all denials were appealed, but in the vast majority of those cases (80.7%) the initial denial was overturned.

Prior authorization determinations represent requests for approval that providers must submit before providing a service. Lawmakers of both major political parties have pressed insurers on their prior authorization practices, which consumers say unfairly erect barriers to needed care.

How Medicare Pays Medicare Advantage Plans: Issues and Policy Options

Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries

1 in 6 Medicare Advantage Enrollees Had a Diagnosis Added on a Chart Review That Increased Federal Payments to their Insurer

Medicare Advantage 2026 Spotlight: A First Look at Plan Offerings

Medicare Part D

Premiums Are Decreasing for Many Stand-Alone Part D Drug Plans in a Number of States in 2026

This analysis finds that monthly premiums for many Part D stand-alone prescription drug plans (PDPs) in a number of states will be lower in 2026 than they were this year. At the same time, the total number of PDPs, which provide prescription drug coverage to people in traditional Medicare, will fall for the third year in a row, as insurers continue to scale back their offerings and adjust to higher costs under the redesigned Part D benefit, reflecting changes in the Inflation Reduction Act.

The Uncertain Future of Medicare's Stand-Alone PDP Market and Why It Matters

Stand-Alone Drug Plans Cover a Larger Share of Part D Enrollees Living in the Most Rural Areas Than Medicare Advantage Plans

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

Data Visualization

The Facts About Medicare Spending

This interactive provides the facts on Medicare spending. Medicare, which serves 67 million people and accounts for 12 percent of the federal budget and 21 percent of national health spending, is often the focus of discussions about health expenditures, health care affordability and the sustainability of federal health programs.

Explore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, and growth in out-of-pocket spending by beneficiaries.

Related: FAQs on Medicare Financing and Trust Fund Solvency

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Medicare Open Enrollment

Beneficiaries Have 32 Medicare Advantage Prescription Drug Plans Available, on Average, for 2026

The average Medicare beneficiary will be able to choose among 32 Medicare Advantage plans with prescription drug coverage for 2026, two fewer than in 2025. The number of MA-PD options has grown steadily since 2010, peaking in 2024 when the average Medicare beneficiary had 36 options. Open enrollment runs October 15 through December 7.

Also: Medicare Open Enrollment FAQs

Premiums Are Decreasing for Many Stand-Alone Drug Plans in a Number of States in 2026

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

The Role of SHIPs in Helping People with Medicare Navigate Their Coverage

What to Know About the Medicare Open Enrollment Period and Medicare Coverage Options

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  • Visualizing Health Policy: Medicare Spending: A Look at Present, Short-Term and Long-Term Trends

    Other Post

    This Visualizing Health Policy infographic with the Journal of the American Medical Association (JAMA) provides an overview of Medicare spending trends in the present, short term and long term. In the long term, Medicare spending as a share of the economy is projected to grow, and Medicare is projected to lack sufficient funds to pay all hospital bills beginning in 2030.

  • How Much of the Medicare Spending Slowdown Can be Explained? Insights and Analysis from 2014

    Issue Brief

    This paper identifies and quantifies, to the extent possible, the factors that explain the gap between actual Medicare spending in 2014 and CBO's 2009 projections of what Medicare spending would be this year. The study synthesizes information from a variety of sources and presents new analysis to assess the extent to which lower-than-projected Medicare spending in 2014 can be explained by deliberate policy and program changes, unexpected trends, and other factors.

  • Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes

    Issue Brief

    This issue brief analyzes the number and variety of Medicare Advantage plan choices available to beneficiaries in 2015. It describes trends in number of Medicare Advantage plans, plan premiums, and plan quality ratings, including changes in prescription drug coverage and limits on out-of-pocket expenses. This spotlight is part of a series of spotlights tracking key changes in the Medicare Advantage program.

  • What Do We Know About Health Care Access and Quality in Medicare Advantage Versus the Traditional Medicare Program?

    Report

    As the number of Medicare Advantage enrollees continues to climb, there is growing interest in understanding how the care provided to Medicare beneficiaries in Medicare Advantage plans differs from the care received by beneficiaries in traditional Medicare. This literature review of more than 40 studies synthesizes the evidence to date comparing access and quality for beneficiaries in Medicare Advantage plans and traditional Medicare.

  • Testimony: Promoting Integrated and Coordinated Care for Medicare Beneficiaries

    Issue Brief

    Gretchen Jacobson, Associate Director of the Foundation's Program on Medicare Policy, testified on June 7, 2017 before the U.S. House Committee on Ways and Means, Subcommittee on Health. Her testimony focused on three approaches for integrating and coordinating care for Medicare beneficiaries, and the opportunities and challenges presented by these approaches.

  • Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

    Issue Brief

    This issue brief presents national and state-level analysis of nursing homes based on the Five-Star Quality Rating System, recently updated by the Centers for Medicare and Medicaid Services (CMS) to help consumers compare nursing homes when selecting one for themselves or their family members. The issue brief finds that more than one-third (36%) of the nation’s 15,500 nursing homes certified by Medicare or Medicaid received relatively low ratings of 1 or 2 stars (out of a possible 5 stars). In 11 states, at least 40 percent of nursing homes in the state have 1- or 2-star ratings. In 23 states, however, at least half of the nursing homes have 4- or 5- star ratings. This issue brief discusses relevant policy considerations regarding nursing home quality—a serious issue in light of the vulnerability of the nursing home population and recent reports of problems arising from inadequate staffing, fire safety hazards, and substandard care.

  • The Policy Implications of Medicare’s New Measure of Financial Health

    Issue Brief

    This report examines a new measure of Medicare’s financial health established by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). The report, authored by Marilyn Moon, takes an in-depth look at the program’s new solvency test, which measures general revenues as a share of total Medicare spending and can trigger a “funding warning” that compels the President to propose and the Congress to consider a funding warning.

  • Decoding the HHS Reorganization

    From Drew Altman

    In his latest column, KFF President and CEO Drew Altman examines the implications of Secretary Kennedy’s reorganization of HHS and why it’s a sharp break from past efforts to reorganize the department.

  • The Role Health PLAYED in the Election

    From Drew Altman

    In his latest column, KFF President and CEO Drew Altman provides an early post-mortem on the role health played in the election, discussing the many ways it did play a role in the campaign — even if not a decisive one.