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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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  • Estimates of Medicare Beneficiaries’ Out-of-Pocket Drug Spending in 2006

    Report

    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. This analysis from November 2004 estimates that 6.9 million beneficiaries are projected to be affected by the coverage gap (the so-called "doughnut hole") in the standard Part D drug benefit.

  • Visualizing Health Policy: The Public’s Health Care Agenda for 2013

    Other Post

    This month’s Visualizing Health Policy infographic looks at the US public’s priorities for health care in 2013, including actions by state governments, Medicaid expansion, Medicare spending, and spending for specific types of public health activities. See the full-size infographic at The Journal of the American Medical Association The original public opinion poll is available here.

  • Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals

    Issue Brief

    This brief provides a side-by-side comparison of Medicare provisions included in broad-based packages to reduce the deficit and debt put forward by the President and the Chairmen of the House and Senate Budget Committees. In addition, this brief summarizes Medicare provisions included in other deficit- and debt- reduction proposals released since January 2012 and describes recent activities that pertain to Medicare and the federal budget, including Medicare’s role in the Affordable Care Act (ACA), the fiscal cliff and sequestration.

  • Medicare Timeline

    Other Post

    In 1965, Medicare was created to provide health insurance for the nation's seniors beginning in 1966. Fifty years later, the program covers over 54 million people - primarily seniors but also others under age 65 with permanent disabilities. Medicare helps pay for a range of medical services, including hospital stays, physician visits, preventive benefits, and starting in 2006, prescription drugs. This timeline provides an overview of changes that have shaped the Medicare program over the past five decades.

  • Development of the Financial Alignment Demonstrations for Dual Eligible Beneficiaries: Perspectives from National and State Disability Stakeholders

    Issue Brief

    This issue brief provides an early snapshot into disability community perspectives on state design and implementation efforts related to the new financial alignment demonstrations for beneficiaries dually eligible for Medicare and Medicaid, with an emphasis on non-elderly beneficiaries and those who use long-term services and supports.

  • Improving the Financial Accountability of Nursing Facilities

    Report

    This report examines nursing facility expenditures to assess relative spending increases in areas such as nursing services, administrative costs, and profits. Using California as a case study, it explores reimbursement by cost category and a standard medical loss ratio (MLR) as potential policy options to improve nursing facility financial accountability and care quality.

  • Medicare: The Essentials

    Feature

    Medicare: The Essentials (July 2013) Download Medicare Enrollment, 1966-2013 Download Source Centers for Medicare & Medicaid Services, Medicare Enrollment: Hospital Insurance and/or Supplemental Medical Insurance Programs for Total, Fee-for-Service and Managed Care Enrollees as of July 1, 2011: Selected Calendar Years 1966-2011; 2012-2013, HHS Budget in Brief, FY2014.

  • 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.

  • Medicare’s Role for Latinos – (Spanish version)

    Other Post

    Medicare's Role for Latinos - (Spanish version) Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation's internal library that could be xeroxed. Please email order@kff.