JustCare

Tag: Prescription drugs

  • How can Pharma defend drug prices in US?

    How can Pharma defend drug prices in US?

    The Biden administration and Congress are concerned about drug prices, they claim. Really? It would be so easy to lower drug prices quickly, simply by opening our borders to drugs from verified pharmacies abroad. Instead, for the first time, the US is negotiating drug prices for ten drugs, and those prices will only be available to Medicare. Noah Weiland and Rebecca Robbins report for The New York Times on a recent Senate HELP Committee hearing.

    The Senate HELP Committee held a hearing on drug prices last week. The heads of three pharmaceutical companies had to defend their prices at the hearing. There was lots of talk and little action about why every other wealthy nation pays less for their prescription drugs than we do.

    CEOs at Johnson & Johnson, Merck and Bristol Myers Squibb admitted that we pay more for our drugs in the US than people in other wealthy countries. In exchange, they claim that we get new drugs sooner. Clearly some spin doctor advised that they praise this “patient choice” in the US. What was left unsaid is that “choice” is only available to the wealthy. Countless Americans cannot afford their drugs even with health insurance because the copays are so high.

    Senator Bernie Sanders, for reasons that I have never understood, is constantly comparing drug prices in the US with those in Canada and sometimes arguing that Americans should be able to import drugs from Canada. Canada has the second highest drug prices in the world. Why not France and England, which have far lower prices?

    Sanders was looking for the CEOs to voluntarily agree to lowering their prices to the same level as Canada. How could they possibly agree to reduce their revenue and profits voluntarily? In fact, they have filed lawsuits against the federal government (which they are so far losing), claiming that negotiated prices for ten drugs through the Inflation Reduction Act is unconstitutional!

    Republicans on the HELP Committee appear to believe that the pharmaceutical market is working. In fact, Congress affords pharmaceutical companies lengthy patent rights and ways to extend them. The pharmaceutical market is fixed to give pharmaceutical companies monopoly pricing power for lengthy periods.

    Senator Romney would like you to believe that the pharmaceutical market works like the automobile market. Not at all. With cars, there’s competition based on lots of known information, including the costs and benefits of the automobile. With drugs, people often don’t know their value. Moreover, the price is rigged by the manufacturers, the pharmacy benefit managers and the health insurers.

    We are paying about three times more than people in other countries for our drugs. Shame on Congress.

    Here’s more from Just Care:

  • Weight-loss drugs are a hot commodity and hard to get

    Weight-loss drugs are a hot commodity and hard to get

    Weight loss drugs are a hot commodity. They can be hard to come by. Getting them can try your patience and your pocketbook. Reed Abelson and Rebecca Robbins offer six reasons why it is so hard for people to get weight-loss drugs in the New York Times.

    1. A lot of people want these drugs. Already nearly four million people are taking weight-loss drugs. Between TikTok and advertisements, more and more people are wanting to take weight-loss drugs.

    2. Production of these drugs is slow. Few factories can manufacture the latest weight-loss drugs. And, they come in five or more strengths. Eli Lilly also needs to make enough of its pens used to inject Zepbound.

    3. Insurance often won’t cover these drugs, making them unaffordable to most. Medicare will only cover these drugs for people with diabetes. It does not cover weight-loss drugs for obesity. However, Medicare covers nutrition and weight-loss counseling.

    Medicaid does not either. The insurers consider them “lifestyle” drugs, rather than medically necessary drugs. As. result about 40 percent of employers also do not offer this coverage to their workers.

    These are injectable drugs that can cost as much as $16,000 a year. With discounts or coupons from Eli Lilly, people can get Zepbound, one of the weight-loss drugs, for $550 a month, if they have insurance. They can get a coupon from Novo Nordisk for Wegovy, another weight-loss drug, and pay $1,000 a month instead of $1,500 a month.

    4. People can’t find these drugs at their pharmacies. While these drugs are often not in stock at pharmacies, they will order them when requested. The drugs cost too much money, literally tens of thousands of dollars for a pharmacy to stock.

    5. Pharmacies sometimes claim that these drugs provide them no profit. In fact, some say that they lose money on weight-loss drugs because the insurers do not reimburse them adequately for the drugs. The insurers’ pharmacy benefit managers or PBMs reimburse the pharmacies below cost in some cases. This seems like a way for the insurers to avoid covering weight-loss drugs.

    6. Most insurers create hurdles in order to cover weight-loss drugs. People need their doctors to verify they qualify for coverage. In some cases, before the insurer will cover these drugs, enrollees must take a six-month nutrition and exercise program. Some insurers require people to try other less expensive drugs before they will cover these drugs.

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  • Drug prices continue to be around three times higher in the US than other wealthy nations

    Drug prices continue to be around three times higher in the US than other wealthy nations

    The Assistant Secretary for Planning and Evaluation or ASPE, a government research agency, released a report showing that US drug prices–brand name and generic–are almost 2.78 times the price in 33 other wealthy countries. Even for people with Medicare Part D prescription drug benefits, drug costs can be high. That will only change when the US negotiates prices for all drugs as every other wealthy nation does for its residents.

    ASPE hired RAND Health Care to conduct the analysis. When RAND compared brand-name drug prices in the US to prices in OECD countries, it found that they were more than 3.20 higher even after adjusting for rebates. It also found that the preponderance of new drugs were first available in the US.

    The US is responsible for a disproportionate and ever larger share of total spending on new drugs as compared with other wealthy nations. The Inflation Reduction Act gave Medicare the ability to negotiate the price of several dozen drugs, beginning with 10 drugs in 2025. But, there are thousands of drugs on the market and working people do not benefit from Medicare’s negotiated prices.

    The price of drugs is rising faster in the US than in other wealthy countries. If you do not factor in rebates, which insurers usually pocket, we pay more than four times the price of people in other wealthy countries for our drugs.

    We pay about two-thirds less for generic drugs than people in other wealthy countries. And, these drugs represent 90 percent of US spending on prescription drugs. These drugs only represent about 41 percent of spending on prescription drugs in other countries.

    Some drugs are particularly expensive in the US. For example, insulin prices are almost ten times higher in the US than in other wealthy countries. We pay more than 10 times what people in France and the UK pay for insulin. We pay six times more than Canadians for insulin. Rebates for people with insurance and people who have met their deductible bring the price of insulin down to 2.33 times what people pay in other wealthy countries.

    While most new drugs launch first in the US, a large number of them launch in other wealthy nations soon after. The researchers found that the drugs that are most beneficial are available in all wealthy countries within a short time.

    Here’s more from Just Care:

  • Biden administration should do more to lower drug costs

    Biden administration should do more to lower drug costs

    In an opinon piece for Scientific American, James Love, Director of Knowledge Ecology International, explains how the Biden administration could do more to lower the cost of prescription drugs in the US. You might not know this but the federal government has the authority to drive competition in the brand-name prescription drug market for brand-name drugs developed with taxpayer support. Many brand-name drugs are developed with your tax dollars.

    Federal agencies can grant licenses to pharmaceutical companies to manufacture drugs that compete with patented drugs with high prices, if the patented drugs were developed with taxpayer dollars. Of course, these are licenses that the pharmaceutical companies that developed the patented drugs do not expect or want to be issued. And, historically, the government has not issued them.

    The federal government has what are called “march-in” rights. It can issue licenses to develop drugs whenever it believes it is necessary to fix a pharmaceutical company’s “abuse or nonuse” of a patented drug. New draft federal guidance clarifies that an excessively high drug price can be considered abusive.

    These “march-in” rights were first established in the Bayh-Dole Act of 1980. Their goal is to ensure that the public benefits from drugs that that are patented, if public dollars contributed to their development. But, over four decades, the federal government has never exercised “march-in” rights, even when pharmaceutical companies set unconscionable prices for their drugs.

    The Biden administration’s new take on the law is significant but still limits the government’s use of its march-in rights and still allows the pharmaceutical companies to set excessively high prices for drugs that were developed with taxpayer dollars. The administration does not suggest that pharmaceutical companies have an obligation to set their drug prices no higher than levels citizens of other wealthy countries pay for the same drugs when US taxpayer dollars funded their development. Right now, we often pay five to ten times more than people in other wealthy countries for the same drugs, developed with our tax money.

    There are not that many new drugs developed with federal funding. And, some of those drugs include patents that were not developed with federal funding. In the administration’s draft, timing, including a patent’s life, could mean that march-in is not a good tack for the federal government to take.

    Moreover, pharmaceutical companies can appeal the federal government’s exercise of march-in rights, which would freeze government action. Essentially, pharmaceutical companies can slow down the march-in process for years, until their drugs lose their patents. And, for obscure reasons, sometimes pharmaceutical companies do not disclose government funding, as in the case of Gleevec, a cancer drug that has generated billions in revenue for Novartis.

    But march-in rights are not the federal government’s only tool for lowering drug prices. Our government has “worldwide royalty-free licenses for a taxpayer-funded invention, and a separate statute allows government use of any patent with compensation—zero for government-funded inventions—set by a judge.” There’s no reason our government should not be using all these rights to ensure Americans can afford the medications they need, especially for Americans in federal programs like Medicare and Medicaid.

    [Editor’s note: I continue to believe that the simplest and swiftest way to pressure the pharmaceutical companies to lower drug prices in the US is to open our borders to prescription drugs from verified pharmacies abroad and require insurers to cover them just as they cover drugs from pharmacies in the US. The Biden administration is now allowing some states to import drugs from Canada, which is another small step in the right direction.]

    Here’s more from Just Care:

  • FDA allows Florida to import lower-cost drugs from Canada

    FDA allows Florida to import lower-cost drugs from Canada

    Finally, in some part thanks to former President Trump and Governor Ron DeSantis, as well as to the Biden Administration’s Federal Drug Administration (FDA), the US plans to open its borders to drug importation, reports Christina Jewett and Cheryl Gay Stolberg for the New York Times. While that is not a long-term fix to unconscionably high drug prices in the US, it is a terrific first step–unless the pharmaceutical industry succeeds at blocking these drug imports.

    To be clear, the FDA only has approved drug importation from Canada. And, as of now, only the state of Florida has approval. But, it is the camel’s nose under the tent and could save Florida as much as $150 million in drug costs in its first year.

    Interestingly, while the Biden Administration supports drug importation, it took a lawsuit by the state of Florida against the FDA to get the the needed federal approval.

    Americans already can buy drugs legally directly from Canadian pharmacies for personal use, but insurers are not required to cover those drugs. They still don’t. But Florida has approval to buy drugs for enrollees in its Medicaid program, people using its health clinics, and people in prison.

    It’s also not clear whether drug importation from Canada will work better for states in theory than in practice. Canada might not have enough supply to provide the drugs Florida needs, let alone the drugs other states will also want to purchase once they have FDA approval.

    You can bet your bottom dollar that Pharma is pulling out all stops to keep drug importation from happening. It plans to bring a lawsuit to prevent Florida from importing drugs from Canada. Moreover, some Canadian drug wholesalers have signed contracts with pharmaceutical companies agreeing not to export their drugs. In addition, Canada does not have a bottomless supply of drugs.

    Time will tell how this story unfolds. Drug importation from Canada was a long time coming. The New York Times reports that Congress passed legislation allowing drug importation 20 years ago, but it is only now that the administration is implementing it. Allegedly, there were “safety” concerns. More likely, there were concerns about PhRMA’s wrath.

    To be clear, patient safety concerns abound in the US because people cannot afford the drugs they need. Too often, they die as a result. And, even more often, they become sick or disabled because they cannot afford to fill their prescriptions.

    There are no reports of people harmed from importing drugs from abroad. Nine million Americans import drugs from abroad every year without incident.

    Colorado, Maine, New Hampshire, New Mexico, North Dakota, Texas, Vermont and Wisconsin have passed laws to allow their states to import drugs and likely many more will do so. Canada should not be the only foreign provider. Many drugs taken in the US are manufactured in India, China and elsewhere. Americans should be permitted to import drugs from verified pharmacies in any country.

    Americans support drug importation. Of course, we do. We import food safely from abroad, and automobiles, and electronics and more. There’s no good reason that we cannot import prescription drugs safely. And, anyone who supports competition should support drug importation, especially since drugs in the US often cost four times more than drugs in other developed countries.

    The big problem with drug prices in the US is that PhRMA can charge pretty much what it will for brand-name drugs. There’s little competition. PhRMA also can keep low-cost generic alternatives off the market for years.

    The Inflation Reduction Act allows our government to negotiate drug prices, which is arguably the best way to bring down drug prices in the US. But, it only allows drug price negotiation for 10 high-priced drugs in the first year, and only for people with Medicare. It’s good, but way less than what we need.

    And, while helpful, Medicare Part D drug plans can still cost you a bundle. If you want to keep your drug costs down, you need to compare your drug copays against the full cost of your drugs at Costco and other low-cost pharmacies. In some cases, you’ll pay less through Costco as this JustCare reader does.

    Before it can begin importing drugs from Canada, Florida must specify the drugs it will import to the FDA and explain how it will ensure they are not counterfeit. Florida also must relabel the drugs.

    Meanwhile, the Canadian government is none too happy about exporting drugs to Florida. The Canadian government could step in if it does not liking the consequences of drug exports. There is understandable worry that a country with fewer than 40 million people will find itself without needed drugs if it exports them to a state with 22 million people, let alone to multiple states with tens of millions more people.

    Here’s more from Just Care:

  • Dozens of drug companies owe Medicare rebates from raising prices higher than the inflation rate

    Dozens of drug companies owe Medicare rebates from raising prices higher than the inflation rate

    The Biden Administration just announced that dozens of drug companies owe Medicare rebates from raising prices higher than the rate of inflation. As a result , hundreds of thousands of people with Medicare will save as much as $2,786 per dose of their prescription drugs.

    The Inflation Reduction Act (IRA) prevents drug price gouging–defined as price increases greater than the rate of inflation–by pharmaceutical companies. The IRA also caps out-of-pocket costs for each insulin drug at $35 a month and limits total out-of-pocket drug costs for people with Medicare through Medicare Part D to $2,000 a year beginning in 2025. Yet, Republicans are trying to repeal the IRA.

    In total, the Administration reports that pharmaceutical companies raised prices on 64 drugs more than inflation. For example, the price of Signifor, which treats an endocrine disorder, went up so much that people who use it could see a savings of $311 for a monthly dose of the drug beginning in January.

    President Biden is also heralding his Administration’s decision to allow the government to “March-in” and help bring down the price of drugs developed with federal funding, if the price is unreasonable. This march-in right has always existed but prior administrations have been reluctant to take the position that the government could step in if a pharmaceutical company charged an excessive for the drug.  Of course, the proof of this Administration’s commitment here is in determining that the price of a drug developed with federal money is too high and taking action. Time will tell.

    Meanwhile a story in Becker’s exposes extreme drug price increases for eight drugs, according to ICER.  The story suggests that insurers spent more than $1.3 billion in these drugs in one year. It’s not clear if that means that individuals paid higher premiums to cover the cost of the drugs, but presumably so. The question left unanswered is whether the insurers recouped that money they spent for these drug, through rebates, and left their enrollees’ holding the bag, a likely scenario.

    Herre’s more from Just Care:

  • President Biden drafts a package of health care reforms for his second term

    President Biden drafts a package of health care reforms for his second term

    President Joe Biden is assembling a package of health care reform proposals for his second term, including a proposal to bring down the price of prescription drugs, reports CNN. It’s a smart move given that health care affordability is the second most important issue for Americans, after inflation.

    At the same time as President Biden looks to enhance people’s health care benefits, former President Donald Trump is calling to repeal the Affordable Care Act (ACA). President Biden wants to keep federal subsidies for people receiving care through the ACA and do more to reduce drug prices for people with Medicare and all other Americans. Biden’s goals are modest given the state of health care in the US and we need to push him to call for affordable health care for all, but his goals are far better than Trump’s.

    The ACA not only gives 10 million more Americans health insurance through the state health insurance exchanges, it expanded Medicaid to cover more Americans. People with incomes up to 135 percent of the federal poverty level are Medicaid-eligible. President Biden is looking into ways to ensure that the three and a half million people in the 10 states that opted against expanding Medicaid have Medicaid coverage.

    President Biden is again calling for a public health insurance option. In theory, such an option could remove the private insurer middlemen and all the waste and increased costs they bring. But, it’s not at all clear, based on Medicare Advantage and traditional Medicare (the public option) that a public health insurance option would bring down costs. The devil is in the design.

    Right now, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, is focused on bringing down the price of ten drugs that cost the Medicare program the most, as required by the Inflation Reduction Act. That’s both the camel’s nose under the tent for lower drug prices and small potatoes. The swiftest and easiest way to bring down drug prices is to allow people to import drugs from abroad and require insurers to cover those far less costly drugs.

    The Inflation Reduction Act also penalizes drug companies for raising drug prices more than the rate of inflation. This measure should keep drug prices from going up at obscene rates. But, it is also small potatoes, given how high drug prices are in the US–often four times higher than in France.

    Here’s more from Just Care:

  • Could weight-loss drugs ultimately reduce health care spending?

    Could weight-loss drugs ultimately reduce health care spending?

    Bruce Japsen reports for Forbes that weight-loss drugs are costing employers $324 per worker each year. These costs will only increase as more workers take these prescription drugs, if the government does not step in to rein in drug prices. They will also drive up Medicare costs a lot if Medicare decides to cover drugs for weight loss. (Medicare covers weight-loss drugs for people with diabetes.) Ideally, weight-loss drugs will reduce the prevalence of diabetes, heart disease and other costly conditions, driving down overall health care spending.

    Right now, Wegovy, Rybelsus and Saxenda as well as Ozempic are responsible for ever higher insurance premiums, deductibles and copays. Their costs likely will keep going up, as more people take them and their manufacturers raise prices. When will our government step in to negotiate prescription drug prices for everyone or, at the very least, open our borders to prescription drugs from verified pharmacies abroad, which are significantly cheaper than in the US and have been shown to be safe.

    In 2021, weight-loss drugs contributed to $96 of insurance costs for each worker. In two years, health insurance costs for these weight-loss drugs are projected to rise to $500 per worker.

    Competition from new weight-loss drugs should contain costs some. And, indeed, Gina Kolata reports for the New York Times that more weight-loss drugs are coming to market. Eli Lilly’s Zepbound, tirzepatide, is the latest to receive FDA approval. But, even if these drugs bring down prices a little, these new drugs are sure to drive up demand. Obesity is rampant in the US, affecting 100 million adults.

    Time will tell the extent to which these new weight-loss drugs affect the overall cost of health care in the US. Zepbound’s initial list price for a four-week dose is $1,060, somewhat less than the price of Wegovy, which is $1,349. But, these drugs are expected to drive down people’s weight by as much as 20 percent, helping to reduce their risk of diabetes, heart disease and other chronic conditions people develop as a result of being overweight. We can only hope that the cost of these drugs will be offset by savings from a reduction in the prevalence of some costly chronic conditions.

    Here’s more from Just Care:

  • Drug prices: Biden v. Trump

    Drug prices: Biden v. Trump

    Heather Landi reports for Fierce Healthcare on how Donald Trump’s former Secretary of Health and Human Services, Alex Azar, and Joe Biden’s current Secretary of Health and Human Services (HHS), Xavier Becerra, would address high drug prices. Not surprisingly, their views differ significantly.

    Azar does not recognize that pharmaceutical companies in the US engage in price fixing. Or, that the pharmaceutical companies often delay the release of new drugs in order to maximize profits on older drugs, hampering innovation. Or, that it’s much easier for people in France to fill their prescriptions than people in the United States because out-of-pocket costs in the US are so high.

    Azar does recognize the power of pharmacy benefit managers, PBMs, to drive up people’s out-of-pocket costs, but does not suggest a plan to fix that issue,. For example, he does not propose removing PBMs from the process of deciding which drugs are covered and at what price to patients.

    Last year, Congress passed the Inflation Reduction Act or IRA, giving Medicare drug price negotiating power for 10 drugs in 2025; the Centers for Medicare and Medicaid Services have chosent the 10 drugs, based on which cost the Medicare program the most. The IRA also capped out-of-pocket costs for each insulin product people with diabetes use at $35 a month. And, it imposed an out-of-pocket limit of $2,000 for drugs covered by Medicare Part D plans beginning in 2025.

    President Joe Biden’s HHS Secretary Becerra touts Medicare’s drug price negotiation power as an effective way to lower drug costs, pointing out that the IRA now caps the cost of insulin at $35 per month for seniors who have Medicare.

    Of note, the Trump administration had proposed that Part B drug prices–for inpatient drugs–be tied to prices paid abroad for these drugs. That sounds to me as if it would have been a smart move. But, the Biden administration rescinded that proposal, likely under pressure from the pharmaceutical industry.

    Here’s more from Just Care:

  • 2024: Medicare Part D coverage and costs

    2024: Medicare Part D coverage and costs

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, Medicare covers the prescription drugs you get from the pharmacy under Medicare Part D. The vast majority of people with Medicare, 50.5 million in 2023, are enrolled in a Part D drug plan. Here’s what you need to know about Medicare Part D coverage and costs in 2024 and why you should take a close look at your options for next year during this annual open enrollment period.

    Don’t assume that your current Part D drug plan will cover your drugs in 2024, even if it does in 2023. Rather, assume that your costs will go up a lot if you didn’t check which Part D plan was likely to save you the most money based on your drug needs, during the Medicare open enrollment period (October 15-December 7). Each year, these Part D private insurance plans can change dramatically. Kaiser Family Foundation offers key facts about Part D plans in 2023.

    As a general rule, close to three in four people enrolled in traditional Medicare and a Part D plan will pay higher costs the following year, if they do not look at their options and switch plans.

    In 2024, there are 709 prescription drug plans available nationally, according to the Kaiser Family Foundation. If you are in traditional Medicare, you will be able to choose from among 15 to 24 Part D plans in your state. 16 national Part D prescription drug plans, with monthly premiums ranging from $6 to $111. The average premium is $43.

    Premiums: Premiums are typically higher for Part D plans offering enhanced benefits, lower cost-sharing and/or low or no deductibles. Standard Part D plans have a base monthly premium in 2024 of $34.70, but it could be higher or lower depending upon multiple factors. Part D “enhanced” plans that charge no or a low deductible have a base monthly premium of $55.50 in 2024.

    If your annual income is $103,000 or higher, you pay a supplemental premium of between $12.90 and $81 a month.

    Standard deductible: The standard and highest possible deductible—the amount you must pay before your coverage begins—is $545, up from $505 in 2023.

    If you have traditional Medicare: You typically will be able to choose among 24 Part D drug plans. Depending upon the state you live in, your options range between 19 and 28.

    If you are in a Medicare Advantage plan: You typically will have a choice  of around 35 Part D drug plans.

    Cost-sharing: For non-preferred brand-name drugs, coinsurance could be as high as 40-50 percent and as low as $0 for preferred generics, depending upon the Part D plan you choose. You also are likely to pay 15-25 percent coinsurance for preferred brand drugs.

    Typically you’ll pay about $1 for preferred generics and $5 for generics. You’ll pay around $44 copay for preferred brands, 45 percent coinsurance for non-preferred drugs, and 25 percent coinsurance for specialty drugs.

    Maximum out-of-pocket: The most you will pay out of pocket for drugs you purchase through Part D is $3,300 in 2024, even though the out-of-pocket spending limit is rising to $8,000 or $12,447 in total drug costs). But the $8,000 includes the value of the manufacturer discount on the price of brand-name drugs during the coverage gap phase of the benefit. If you only use brand-name drugs, you will only have to pay around $3,300 out of pocket.

    Also, keep in mind that in 2025, your maximum out-of-pocket cost for drugs covered through Part D will be $2,000 because of the Inflation Reduction Act.

    Costs in each coverage phase: After you have paid your deductible, you are in the initial coverage phase, where you generally will pay around 25 percent of the cost of both brand-name and generic drugs until your drug costs total $5,030. You will then be in the coverage gap phase, where you will be responsible for about 25 percent of the cost of your drugs. Once your out-of-pocket drug costs, including the deductible, but not your Part D premium, total  $8,000 in the coverage gap phase (in fact, around $3,300 plus manufacturer discounts,) you will be in the catastrophic coverage phase. At that point, you will pay nothing more for your covered drugs.

    If you qualify for a low-income subsidy (LIS) or Extra Help: You will have lower out-of-pocket costs, depending upon the Part D plan you choose and the drugs you use. You should pay $4.50 for each generic drug that is covered and $11.20 for each brand-name covered drug. Around 13 million people with Medicare qualify for extra help with their prescription drug costs. There are 198 Part D drug plans for which you will not pay a premium. You can also choose a “non-benchmark” plan and pay a portion of the monthly premium.

    You should get Extra Help automatically if you have full Medicaid benefits or are receiving SSI benefits. If not, you can apply for Extra Help through the Social Security Administration. To qualify, generally, an individual’s countable income needs to be below $21,870 and your assets need to be below $16,600.

    If you need insulin: The Inflation Reduction Act limits your monthly copayment to no more than $35 in all phases of Part D coverage. However, that limit applies only to insulin in a plan’s formulary, not all insulin products.

    If you need a vaccine: Vaccine costs are covered in full for vaccines that are on the Part D formulary.

    Here’s more from Just Care: