Recent changes to Medicare’s Part D prescription drug benefit, introduced through President Biden’s Inflation Reduction Act, aim to help seniors afford their medication costs. However, while some of these changes offer significant savings, others could inadvertently increase expenses, limit access to medicines and slow the development of new treatments.

As open enrollment season approaches—from October 15 to December 7—it’s crucial for seniors to understand how these changes may affect their Medicare coverage.

THE GOOD NEWS

Seniors using insulin now have their monthly costs capped at $35, which has already made a huge difference for those with diabetes.

Starting next year, out-of-pocket drug costs under Part D will be capped at $2,000 annually. Additionally, a new Medicare Prescription Payment Plan will allow seniors to spread their pharmacy costs throughout the year. Both measures can help seniors, particularly those on fixed incomes or who rely on multiple brand-name medications.

Currently, very few enrollees are aware of this new program. Medicare could do more to promote this option, as it requires seniors to actively opt in. During this year’s open enrollment, seniors should reach out to their Part D insurers to see if spreading out costs could benefit them.

POTENTIAL DOWNSIDES

One of the most controversial changes under the Inflation Reduction Act is Medicare’s new ability to set prices for certain drugs. While this is meant to control costs, it has had unintended consequences for drug development. Already, the law has led to the discontinuation of at least 36 research programs and 22 experimental drugs.

Additionally, the law has contributed to higher premiums. This year, standalone Part D plans were projected to cost seniors an average of 21% more than last year, leading many to switch to cheaper options. The number of available plans has also decreased by about 25% since 2020.

The Inflation Reduction Act has also prompted some insurers to shift medications into “non-preferred” or “specialty” tiers that require higher out-of-pocket costs, limiting access to previously covered drugs. Others have imposed new rules, such as requiring patients to try lower-cost alternatives before being approved for the medications their doctors prescribe.

BE PREPARED

It’s important for seniors to stay informed about these changes and their potential effects on medication access and costs before open enrollment begins in October. Being proactive and reviewing options could help minimize negative impacts on your healthcare. 

Kenneth E. Thorpe is the chairman of the Department of Health Policy and Management at the Rollins School of Public Health at Emory University and chairman of the Partnership to Fight Chronic Disease.