Part D 2025 Rule Changes

[Duaine]

Well I was going to send in my $166.00 but my car broke down, my cat died and oh yeah I had to buy those Lotto Tickets. I'm sure to WIN..!!!

 

[straightnochaser]

If Medicare doesn't get this under control ie no drug higher here than Canada it will make Medicare go insolvent in the next 5 yrs.
This $2,000 max out of pocket and we will put you on a payment plan will do 1 thing .......Everyone that is paying the $166mo or has meet the $2000 yearly max will have no care about what their drug cost are.
Doctor to patient...... these 3 drugs are going be expensive . Maybe $2k-3k for the first 2 and the 3rd one runs $7,500 year. Doctor it's fine I've already met my max. Just paying $166 a month. Nah I don't see any problems.

Insurers can still require PA, Step-Therapy etc.. if there's a cheaper alternative I guarantee they'll be made to take that first.

 

[Millwood]

Insurers can still require PA, Step-Therapy etc.. if there's a cheaper alternative I guarantee they'll be made to take that first.

And then the real fights between Doctor and patient vs insurance will begin. It's going to be brutal!!

 

[somarco]

The $2k cap will blow up in Congress' face. I get so tired of politicians coming up with vote buying schemes that will never stand a chance of succeeding.

 

[straightnochaser]

And then the real fights between Doctor and patient vs insurance will begin. It's going to be brutal!!

So same as before?

 

[Chazm]

I don’t want to be political, but if Trump were to win, could he reverse that policy? Or would it take too long?

 

[DonP]

I don’t want to be political, but if Trump were to win, could he reverse that policy? Or would it take too long?

All cms policy will be set for 2025 even if Trump gets elected. Rules are preset in November . Nothing with Medicare will really change before 2026

 

[somarco]

I don’t want to be political, but if Trump were to win, could he reverse that policy? Or would it take too long?

It's a done deal . . . baked into the IRA (inflation reduction act). Premium rates and formularies must be filed with CMS by July (maybe August).

Some folks have already benefitted this year from the 2024 cap and $0 cat coverage.

You can't put this genie back in the bottle any more than Obamacare can be rolled back.

Most seniors are screwed . . . the only ones that benefit are those with very expensive tier 4,5,6 meds.

 

[Millwood]

So same as before?

Great question (rhetorical I get it), but My 2 cents.........Now tons of people just won't take the medications because of cost. And Doctors understand that as well.
With new rules and breaking down cost to more than $166 mo.
there will tons of beneficiaries and Doctors trying to get these expensive drugs.
Yes there is step therapy, prior authorization etc, but we have never had a the demand before because of the cost to the consumer. Once that is removed the floodgates will open with Doctors and beneficiaries demanding coverage. Probably class action lawsuits etc. There is nothing the general public hates more than Insurance Companies telling them NO and Drug Company graft. MAPD company won't approve their high cost drugs they will have a negative opinion of the company as a whole. Welcome to the Sheaught Show.

 

[Special Agent]

If Medicare doesn't get this under control ie no drug higher here than Canada it will make Medicare go insolvent in the next 5 yrs.
This $2,000 max out of pocket and we will put you on a payment plan will do 1 thing .......Everyone that is paying the $166mo or has meet the $2000 yearly max will have no care about what their drug cost are.
Doctor to patient...... these 3 drugs are going be expensive . Maybe $2k-3k for the first 2 and the 3rd one runs $7,500 year. Doctor it's fine I've already met my max. Just paying $166 a month. Nah I don't see any problems.

Yes 2025 will be a real Ozempicpaloolaza!I am sure we will see that big gal that does that broadway style song and dance number for Jardiance on TV even more next year.