While this model will continue in 2023, beneficiaries do not need to enroll in one of the model-participating plans to benefit from the $35 monthly copay cap for insulin. In 2023, a total of 2,881 Part D plans will participate in this model (a 33% increase over 2022), including 324 PDPs and 2,557 MA-PDs (including segmented plans). This new requirement builds on a current Innovation Center model, the Part D Senior Savings Model, in which only participating enhanced Part D drug plans cover insulin products at a monthly copayment of $35 in the deductible, initial coverage, and coverage gap phases of the Part D benefit. In 2023, under a provision in the Inflation Reduction Act, Part D enrollees will pay no more than $35 per month for covered insulin products in all Part D plans. Although the number of PDP options for 2023 is far lower than the peak in 2007 (when there were 56 PDP options, on average), Medicare beneficiaries continue to have numerous drug plan options.Īvailability of Insulin For $35 Per Month The average Medicare beneficiary will have a choice of 24 PDPs in 2023, 1 more PDP option than in 2022 (Figure 1). Part D Plan Availability The Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans with Part D Drug Coverage in 2023 The law also adds a hard cap on out-of-pocket drug spending under Part D by eliminating the 5% coinsurance requirement for catastrophic coverage in 2024 and capping out-of-pocket drug spending at $2,000 in 2025, and authorizes the federal government to negotiate drug prices under Medicare, with negotiated prices for 10 Part D drugs first available in 2026. Also beginning in 2023, drug manufacturers will be required to pay rebates for drug prices that rise faster than the rate of inflation, which could impact costs for Part D enrollees. Beginning in 2023, under a provision in the Inflation Reduction Act, Part D enrollees will pay no more than $35 per month for covered insulin products in all Part D plans, and will pay no cost sharing for adult vaccines covered under Part D.Most Part D PDP enrollees who remain in their current plan for 2023 will be in a plan with the standard (maximum) $505 deductible. Close to half of all PDP enrollees will also face coinsurance, rather than copays, for preferred brands, ranging from 15% to 25% coinsurance can mean less predictable out-of-pocket costs than copayments. Most PDP enrollees will face much higher cost sharing for brands than for generic drugs, including coinsurance for non-preferred drugs between 40% and 50% (the maximum coinsurance rate allowed for the non-preferred drug tier) in 12 of the 16 national PDPs, similar to recent years.Among the national PDPs, average monthly premiums are increasing for 12 PDPs, including 4 PDPs with increases exceeding $10. Average monthly premiums for the 16 national PDPs are projected to range from $6 to $111 in 2023.The estimated average monthly premium for Medicare Part D stand-alone drug plans is projected to be $43 in 2023, based on current enrollment, a 10% increase from $39 in 2022 – a rate of increase that outpaces both the current annual inflation rate and the Social Security cost-of-living adjustment for 2023.Of this total, 191 PDPs will be premium-free for enrollees receiving the Low-Income Subsidy (LIS) (benchmark plans). A total of 801 PDPs will be offered in 2023 nationwide, a modest increase from 2022.
Unless otherwise noted, weighted estimates are based on June 2022 enrollment (see Methods box for additional details). ( A separate overview of the 2023 Medicare Advantage market is also available.) The brief also describes the provisions in the Inflation Reduction Act of 2022 that affect the Medicare Part D marketplace beginning in 2023.
This issue brief provides an overview of the Medicare Part D marketplace in 2023 and key trends over time, focusing primarily on PDPs. In 2022, 49 million of the 65 million people covered by Medicare are enrolled in Part D plans, with more than half (53%) enrolled in MA-PDs and 47% in PDPs. During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D prescription drug coverage, either a stand-alone prescription drug plan (PDP) for people in traditional Medicare, or a Medicare Advantage plan that covers all Medicare benefits, including prescription drugs (MA-PD).
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