Medicare Prescription Drug Cost Changes for 2024

“People with Medicare deserve to have access to accurate information when making coverage choices and to be able to get the care they need without excessive burden or delays,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare.

The Centers for Medicare & Medicaid Services (CMS) confirmed that premiums, benefits, and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain constant in 2024.

In 2024, Medicare Part D enrollees will experience significantly higher cost-sharing for brand-name and non-preferred drugs compared to generic-tier drugs. The standard cost-sharing for different types of drugs among all Part D Prescription Drug Plans (PDPs) includes:

1. Generics: $0 for preferred generics and $5 for other generics.
2. Preferred brands: A copayment of $47 or coinsurance of 21% for preferred brands, up from $44/17% in 2023.
3. Non-preferred drugs: 46% coinsurance for non-preferred drugs, including both brands and generics (an increase from 45% in 2023; the maximum allowed is 50%).
4. Specialty drugs: 25% coinsurance for specialty drugs, consistent with the 2023 level (the maximum allowed is 33%)

This information reflects the typical five-tier formulary design in Part D, encompassing preferred generics, generics, preferred brands, non-preferred drugs, and specialty drugs.

President Biden signed the Inflation Reduction Act of 2022 into law, it includes a number of provisions to lower prescription drug costs for Medicare beneficiaries and lower federal drug spending. The Inflation Reduction Act includes provisions to make the Part D benefit more generous, such as eliminating the 5% coinsurance requirement for catastrophic coverage starting in 2024. This will help lower out-of-pocket costs for enrollees, but it may become challenging for some PDP sponsors to offer low-priced coverage, especially for stand-alone drug plans.

According to the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), they have finalized a rule for people with Medicare D to put first and be a priority to make sure that they make the most of the benefits and protection of Medicare Advantage (MA) works for them. 

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