For Physicians. By Physicians.
For Physicians. By Physicians.
The Inflation Reduction Act (IRA) 2025 introduced changes to Medicare Part D prescription drug benefits that affect costs and benefits. The IRA introduced several changes in 2025, including a $2000 annual cap on out-of-pocket expenses; insulin copay limit of $35; $0 copay for most Part D vaccines; and increased sponsor plan financial responsibility for patients with high drug costs. A recent paper (Cai et al. JAMA, 2025) examined whether these changes that increase risk and constrain plan design for Part D plan sponsors would disadvantage beneficiaries whose coverage would be interrupted due to plans leaving the marketplace.
From 2018 to 2023, 0.1% to 2.3% of beneficiaries lost their Part D insurer the following year, compared with 7.5% of beneficiaries (2.9 million) in 2024. This included 2.0 million of 18.2 million (10.8%) in standalone Part D plans (PDPs) and 0.9 million of 20.1 million (4.5%) in Medicare Advantage prescription drug (MAPD) plans. Furthermore, 2.8 million of 31.1 million (8.9%) in enhanced plans and 89,572 of 7.1 million (1.3%) in standard plans lost their plan.
In summary, for the years 2023 and 2024, these results demonstrate that more Part D beneficiaries were impacted by their insurer leaving the marketplace than in prior years. A possible cause could include the increased Part D sponsor financial liability. Although the IRA goal was to lower costs for patients, increased Part D plan exits could lead to more limited coverage options and less competitive Part D marketplaces. An unintended consequence to patient health could be differences in plan formularies when it comes to certain medications and the potential to disrupt medication compliance. While patients could comparison shop to check for their specific medications, comparison shopping for Medicare coverage is a daunting task that most patients do not undertake.
Insurer Exits After the Inflation Reduction Act Part D Redesign
Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period
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