Rolling Out the Changes to Medicare’s Prescription Drug Benefit: How Cost Sharing Is Becoming More Affordable

The expansion of Extra Help and the effort to get the word out about eligibility may also help to reach the millions of Medicare enrollees that may be eligible for Extra Help but are not enrolled. [...] Cost sharing in Medicare Part D changes throughout the year as beneficiaries move through the different phases of coverage as shown in the chart below. [...] While it is beneficial for the client to hit an out-of-pocket maximum early in the plan year, fewer months in which there is a cost sharing charge for the ADAP to pay may reduce the savings an ADAP is able to generate from manufacturer rebates, thereby reducing the amount the ADAP can reinvest back into the program. [...] CMS is still working out the details of how the smoothing option will work, and there may be opportunities for advocates to weigh in to ensure that this option is as accessible and understandable as possible for those who stand to benefit from it. [...] Starting in 2025, total out-of-pocket costs for Medicare Part D will be capped at $2,000, and beneficiaries will be able to spread out their drug costs over the course of the year thro...