Medicare Part D in 2025: Preferred Pharmacy Networks Fade in a Collapsing PDP Market

[Duaine]

Ponder just how badly the Congressional Budget Office (CBO) misprojected the IRA's impact on Part D. So far, CBO has admitted that it underestimated true costs of IRA by $10 to $20 billion. What's more, CMS's Part D "demonstration" handout to plans will cost $5 billion (plus another $2 billion in interest over the next 10 years). Yet the PDP market still tanked.

DEPARTING PART D

Here are the 2025 network highlights from the five major companies with national stand-alone PDPs. These companies account for 408 (88%) of the total 464 PDPs. Two of the 12 companies’ plans will have an open retail network. The other 10 plans will have preferred cost sharing networks.

• Aetna Medicare will offer only the legacy CVS Health SilverScript Choice plan. It has terminated the SilverScript Plus and SilverScript SmartSaver plans. For 2025, SilverScript Choice will switch from a preferred retail network to an open network.

• Cigna is offering three plans: Extra, Saver, and Assurance. Cigna introduced the Saver plan for 2023, and it includes low premiums, low copays, and an emphasis on generic drug savings. The Assurance plan will replace the current Secure Rx plan. Note that Express Scripts does not offer its own plans separately from Cigna.

• Humana is offering two of the plans—Humana Basic Rx and Humana Premier Rx Plan—that it has offered since 2020. For the first time since 2011, however, Humana will not offer a co-branded plan with Walmart. Instead, the Humana Walmart Value Rx Plan has been renamed as the Humana Value Rx Plan. The Humana Basic Rx plan switched from an open network to a preferred retail network for 2021, but switched back to an open network for 2024 and 2025.

• UnitedHealthcare (UHC) is offering only two AARP-branded plans. Both plans—AARP Medicare Rx Preferred and AARP Medicare Rx Saver—were offered for 2024. For 2025, UHC will no longer offer the co-branded AARP MedicareRx Walgreens plan or its Rx Basic plan.

• WellCare, which is now part of Centene, is offering three plans in 2025: Wellcare Classic; Wellcare Value Script; and Wellcare Medicare Rx Value Plus. All three plans have been available since 2020.

There are two notable market exits for 2025:

• Mutual of Omaha, which had launched its plans in 2019, will not offer any Part D plans for 2025. For 2024, it had offered three plans: Rx Essential, Rx Plus, and Rx Premier.

• Clear Spring Health will not offer any plans for 2025. For 2024, Clear Spring offered only one plan. However, CMS terminated the company’s Medicare Part D contract, effective December 31, 2024. CMS’s September landscape file inadvertently listed Clear Spring Health’s plans, which explains the discrepancy between our PDP count and the other sources noted above.

[EXTERNAL LINK] - Medicare Part D in 2025: Preferred Pharmacy Networks Fade in a Collapsing PDP Market

 

[somarco]

Part D contributed to the rapid rise in the cost of medicine since 2006. This is a pattern seen in many industries where insurance, or other financial subsidy, makes a product more affordable to the end consumer, resulting in increased demand for "inexpensive" products or services, leading to inflated pricing and profits.

The federal student loan program caused rapid, substantial tuition increases

Introducing low health care copays that replaced front end deductibles on health insurance fueled health care coverage rising premiums.

Relaxed home mortgage underwriting wiped out the substandard loan industry and created no doc "liar" loans which led to the collapse of the home lending market.

Government taxpayer subsidies for EV's resulted in the rapid demand and availability of battery powered cars. That market is already collapsing as many car manufacturers are cutting back production as profits and demand for the vehicles is waning.

I am from the government and I am here to help you have become words of fear . . . .

 

[DNicholsIns]

It’s crazy how the CBO underestimated the costs of the IRA, and now we’re seeing even more issues with Part D. The market seems to be collapsing despite all the extra handouts and changes to the plans. The exits of companies like Mutual of Omaha and Clear Spring Health just add to the confusion. Honestly, it feels like every time the government steps in to help, it ends up causing more problems in the long run, just like we’ve seen in other sectors.