Medicare Drug Cost Cap: Lower Out-of-Pocket Expenses for Beneficiaries
This act aims to reduce drug costs for individuals enrolled in Medicare Part D by limiting monthly out-of-pocket expenses to the drug's net price. Starting in 2027, your monthly co-payments for covered drugs will not exceed the average net price after rebates. This measure is designed to protect beneficiaries from high drug costs, especially before reaching their annual out-of-pocket spending threshold.
Key points
Effective January 1, 2027, monthly cost-sharing for Medicare Part D drugs will be capped at the average net price (after rebates) or the applicable cash price, whichever is lower.
This change is intended to alleviate financial burdens for Medicare beneficiaries currently facing high out-of-pocket drug costs before reaching their spending limits.
The act mandates a report from the General Accountability Office (GAO) by 2029 to analyze compliance, enforcement, and recommend improvements for these new provisions.
Introduced
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