Medicare out-of-pocket cap on prescriptions takes effect

WASHINGTON, D.C. — More than 70,000 seniors in Washington state will save hundreds or thousands of dollars each year thanks to the new annual cap on out-of-pocket prescription drug costs for folks on Medicare Part D, according to an announcement from the office of Sen. Patty Murray, D-Wash. 

The new cap is part of the Inflation Reduction Act passed by Congress in 2022, and it means seniors will pay significantly less for their prescription drugs this year, lowering costs for families and giving them more breathing room, according to the announcement. 

“Starting Jan. 1, anyone with a Medicare prescription drug plan – also known as Medicare Part D – now has their out-of-pocket drug costs capped at two thousand dollars each year,” Murray wrote in the announcement. “ … As everyone knows, high drug prices come with other painful costs – like stress over how to make ends meet, or what bills to skip in order to fill a prescription, or whether to take the risk of rationing medication. These are impossible choices that no one should ever have to make. But they’re the reality for so many people, and so many seniors especially.” 

Medicare Part D – a voluntary program that helps pay for prescription drugs for people with Medicare – provides prescription drug coverage for nearly 56 million Americans. More than 4.5 million older Americans enrolled in Part D are estimated to benefit from the new out-of-pocket spending cap that took effect Jan. 1. Approximately 1.4 million Part D enrollees who reach the new out-of-pocket cap between 2025 and 2029 will see annual savings of $1,000 or more, and just over 420,000 will see savings of more than $3,000. In Washington state, at least 70,000 seniors are expected to see these new savings – nearly $1,900 in 2025 – and that number will steadily increase over time. 

The $2,000 annual cap is one way the Inflation Reduction Act lowers prescription costs, according to the announcement. The law also capped the cost of insulin for patients on Medicare at $35 per month – which went into effect Jan. 1, 2023 – and it empowered Medicare to negotiate lower prescription drug prices for the first time ever. 

Also included in the Inflation Reduction Act: 

• In August, the Centers for Medicare & Medicaid Services announced negotiated drug prices for ten commonly used drugs in the first cycle of negotiations. The new, lower negotiated prices will go into effect Jan. 1, 2026, and will lower the prices people pay for some of the most common and expensive prescription drugs that treat heart disease, cancer, diabetes, blood clots and more. 

• Allowing Medicare to negotiate prescription drug costs is expected to save American taxpayers $6 billion, with people enrolled in Medicare expected to save $1.5 billion in out-of-pocket costs in 2026 alone. Fifteen to 20 more drugs will be added to the negotiating table every year moving forward. 

“Make no mistake, when prescription drugs are too expensive for people to afford – that’s dangerous,” Murray wrote in the announcement. “Because even the best, most effective medication can’t do someone any good if they can’t afford to get it.”