A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare. This law improves access to affordable treatments and strengthens the Medicare program. Here’s what the law means for you:
More vaccines covered
People with Medicare Part D drug coverage now pay nothing out-of-pocket for even more vaccines. Your Part D plan won’t charge you a copayment or apply a deductible for vaccines that the Advisory Committee on Immunization Practices recommends, including the vaccines for shingles, whooping cough, and more.
Lower costs for insulin
Your Medicare drug plan can’t charge you more than $35 for a one-month supply of each Part D-covered insulin, and you don’t have to pay a deductible for your insulin. Other questions about insulin coverage?
- If you get a 2- or 3-month supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin.
- If you take insulin through a traditional pump that’s covered under Medicare’s durable medical equipment benefit, that insulin is covered under Medicare Part B — these benefits go into effect on July 1, 2023.
Lower out-of-pocket drug costs
Starting April 1, 2023, you might pay a lower coinsurance amount for certain drugs and biologicals covered by Part B, if their prices have increased higher than the rate of inflation. The specific drugs and potential savings change every quarter.
- If you have drug costs high enough to reach the catastrophic coverage phase in your Medicare drug coverage, you won’t have to pay a copayment or coinsurance, starting in 2024.
- Extra Help affording prescription drug coverage (the Part D Low-Income Subsidy (LIS) program) will expand to certain people with limited resources who earn less than 150% of the federal poverty level, starting in 2024.
- Your yearly Part D out-of-pocket costs will be capped at $2,000, starting in 2025. You’ll also have the option to pay out-of-pocket costs in monthly amounts over the plan year, instead of when they happen.
Medicare will negotiate to get you lower drug prices
For the first time, Medicare will be able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that don’t have competition.
This year, we’ll announce the first 10 drugs selected for negotiation. Negotiated prices for these first 10 drugs will be effective in 2026.
Medicare will select and negotiate costs for:
- 15 Part D drugs in 2025 (effective in 2027)
- 15 Part B and Part D drugs in 2026 (effective in 2028)
- 20 Part B and Part D drugs in 2027 (effective in 2029)
- 20 Part B and Part D drugs in 2028 and every year after
Manufacturers that don’t follow the negotiation requirements will have to pay a tax, and will have to pay penalties if they don’t fulfill other manufacturer requirements.