under Part D, Medicare’s outpatient drug benefit. The cap on copays and coinsurance for prescription drugs is
another critical cost-saving measure resulting from the Biden Administration’s Inflation Reduction Act and
comes on top of the elimination of 5% coinsurance in the catastrophic coverage phase of the Part D benefit, in
effect for 2024.
“There is already a $3,200 out-of-pocket cap in place under Part D this year,” said Joseph Peters, Jr.,
Secretary-Treasurer of the Alliance. “The $2,000 cap in 2025 will bring seniors and their families even more
relief.”
An analysis from KFF Health News found that, from 2012-2021, an estimated 5 million Part D beneficiaries
faced out-of-pocket drug costs that exceeded $2,000. KFF now predicts that 1.5 million Medicare beneficiaries
could save money in any single year thanks to the cap.
Importantly, those with especially serious conditions like cancer and rheumatoid arthritis, who are the most
likely to spend thousands upon thousands on out-of-pocket costs, will benefit the most from the cap.
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