Published October 2024

As we head into the Medicare Annual Open Enrollment period, it is important to note changes coming to prescription drug coverage in 2025.

No "Coverage Gap"

There will be only three Part D Payment Stages in 2025: the Deductible Stage (depending on the plan), Initial Coverage Stage, and Catastrophic Coverage Stage. The “Coverage Gap” (or “donut hole”) stage, during which drug costs could significantly increase, has been eliminated.

$2,000 Out-of-Pocket Maximum for Covered Prescriptions

In 2025, all Part D plans have an out-of-pocket maximum of $2,000. This means that once Members have paid $2,000 for Part D covered prescriptions, they will pay nothing for covered prescriptions at the pharmacy through December 31. This is significantly lower than the 2024 out-of-pocket maximum of $8,000.

Medicare Prescription Payment Plan

Participation in this payment plan option helps Members spread their prescription costs out over the entire year. It will not save them money or lower their drug costs.

2025 MVP Formulary Changes

In 2025, nearly 270 drugs will be covered at a lower cost, including prescriptions for blood pressure and other heart conditions, respiratory conditions, antibiotics, and mental health. Some drugs will have a tier increase, require prior authorization, or have additional requirements. You will soon receive information about Members who will be impacted by these changes. Please help them switch to an appropriate medication that is on the 2025 MVP Formulary or complete necessary prior authorizations before January 1, 2025.

Extra Help for Medicare Members

There are several programs that can help lower costs for Medicare Members that have limited income and resources. Many people qualify for savings and do not realize it. More information can be found here or by contacting a local Social Security office.