Expensive drugs and Medicare Part D: how the costs work

• Many plans have a deductible before they start sharing drug costs.
• Drugs are grouped into tiers, and specialty drugs often sit in the highest, with the highest share of cost.
• Plans can require approval, trying another drug first, or limits on quantity.
• Part D has a yearly cap on out-of-pocket drug costs. It was $2,000 when it began in 2025 and is adjusted each year.

Two plans can have very different costs for the same medicine, and a plan's drug list can change from year to year. Check the list for the year you are enrolling in, and check again at open enrollment.

• The exact name and strength of each expensive drug
• How often you take it
• The pharmacy you use
• Whether you use a specialty pharmacy

• The Medicare Prescription Payment Plan: spreading out drug costs
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