A series of changes to the Medicare Program are scheduled to being in January of 2023.   They were brought about by the Inflation Reduction Act signed into law on August 16, 2022.   The changes to the Medicare prescription drug program will be rolled out over the next several years.

The big change beginning next year affects those who need to purchase insulin.  Whether you take a prescription drug or use a traditional pump, you will now have to pay no more than $35.00 per month under traditional Medicare.   You also won’t pay a deductible for your covered insulin products.    For those with prescription drug plans, the changes take effect on January 1, 2023.  Those who use a traditional pump covered under Medicare’s durable medical equipment benefit, will see the change take effect on July 1, 2023.   Approximately 1.4 million people with Medicare will be affected by this change.

Also beginning in 2023 is a change to co-pays for many vaccinations.  For those getting vaccinated in 2023 for any vaccine recommended by the Advisory Committee on Immunization Practices, including shingles, you will not have to pay anything out of pocket.

Starting in 2024, those who are enrolled in a prescription drug plan and who have such high drug costs that they reach the catastrophic phase of Medicare drug coverage ($7400 in 2023), will no longer have to pay the cost-sharing toward their prescription drugs in the catastrophic phase.   Also expanding in 2024 is a prescription drug coverage program known as the Low-Income Subsidy Program (LIS) that helps those with low incomes pay for prescription drugs.  The change to the program increases those that are eligible to those with incomes equal or less than 150% of the federal poverty level ($20,385 for an individual and $41,625 for a family of four in 2023).

There are many changes coming up affecting how consumers pay for prescription and generic drugs.   In 2025, there will be a cap on what people pay out of pocket for prescription drugs.   The cap will be $2,000 and can be spread out over the year rather than paying it all at once.  Down the road in 2026, Medicare will start negotiating drug prices.  The first 10 drugs will be chosen in 2023.  They are likely to be the highest spending brand name drugs that don’t have competition.


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