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Prescription Drugs

Recent Trends in GLP-1 Use and Spending in Medicare

New data from the Centers for Medicare & Medicaid Services shows that use of and spending for GLP-1 drugs under Medicare grew substantially between 2019 and 2024. Medicare covers GLP-1 drugs for diabetes, cardiovascular disease, and sleep apnea, but current law prohibits Medicare from covering drugs for weight loss.

FAQs About the IRA's Medicare Drug Price Negotiation Program

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

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

The top three pharmacy benefit managers (PBMs) manage 79% of prescription drug claims on behalf of 270 million people. We look at the role PBMs play in influencing drug costs and access to medicines, as well as efforts to regulate them.

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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  • Medicare Part D in Its Ninth Year: The 2014 Marketplace and Key Trends, 2006-2014

    Report

    This report presents findings from an analysis of the Medicare Part D marketplace in 2014 and changes in features of the drug benefit offered by Part D plans since 2006. It examines the latest information and trends related to Part D enrollment and plan availability, premiums, benefit design and cost sharing, pharmacy networks, the Low-Income Subsidy Program, and plan performance ratings.

  • Drew Altman: 3 Takeaways From the Medicare Trustees Report

    News Release

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman dives into this week’s release of the Social Security and Medicare Trustees Report to discuss the good news that may have been missed. All previous columns by Drew Altman are available online.

  • Independent Payment Advisory Board (IPAB) Process: A Timeline

    Feature

    IPAB Timeline Download Source Kaiser Family Foundation, “The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending,” 2011, https://www.kff.org/health-reform/issue-brief/the-independent-payment-advisory-board-a-new/.

  • Modifying Medicare’s Benefit Design: What’s the Impact on Beneficiaries and Spending?

    Report

    This report examines an approach to reforming Medicare that has been a focus of Congressional hearings and featured in several broader debt reduction and entitlement reform proposals, and was included in the June 2016 House Republican health plan. The analysis models four different options for modifying Medicare's benefit design, all of which include a single deductible, modified cost-sharing requirements, a new cost-sharing limit, and a prohibition on first-dollar Medigap coverage. The analysis models the expected effects on out-of-pocket spending by beneficiaries in traditional Medicare, and assesses how each option is expected to affect spending by the federal government, state Medicaid programs, employers, and other payers, assuming full implementation in 2018.

  • Modifying Traditional Medicare’s Benefit Design Could Reduce Federal Spending But With Cost Tradeoffs Between Beneficiaries and The Federal Government

    News Release

    Revamping traditional Medicare’s benefit design and restricting “first-dollar” supplemental coverage could reduce federal spending, simplify cost sharing, protect against high medical costs, decrease out-of-pocket spending for many beneficiaries, and provide more help to those with low incomes -- but would be unlikely to achieve all of these goals simultaneously.

  • How the Republican Health Agenda Could Play Out

    From Drew Altman

    In this Wall Street Journal Think Tank column Drew Altman discusses how Republicans will assume ownership of health care’s policy and political problems as they assume control, and how that may affect their plans for the Affordable Care Act, Medicaid and Medicare.

  • What Paul Ryan’s Stance on 2016 Means for Health Care

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman discusses the implications of Paul Ryan’s decision to rule out being drafted as a Republican presidential candidate for the 2017 health care agenda and how it could focus greater attention on proposals to change Medicare and Medicaid along with the Affordable Care Act.