A new prescription drug law that went into effect on 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:

Lower costs for insulin

Your Medicare drug plancan’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.
• Between January 1, 2023, and March 31, 2023, if you pay more than $35 for any month’s supply, your plan must reimburse you within 30 calendar days for any amount you paid above the $35 cap. (Plans have until March 2023 to update their systems. Contact your plan if you haven’t been reimbursed within 30 days.) 
• Get more information about this new insulin benefit. 

Improved Part D Coverage

If you have Medicare drug coverage (Part D), you’ll have lower out-of-pocket costs and better access to vaccines.

• 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.
• People with Medicare Part D drug coverage now pay nothing out-of-pocket for even more vaccines, including the shingles vaccine, that are recommended by the Advisory Committee on Immunization Practices.

Medicare will negotiate to get you to 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.

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