I have severe rheumatoid arthritis and my biologic medication costs $6,000 per month. How will the 2025 Medicare Part D changes affect someone in my situation?

Question

Scott Sims · Accepted Answer

Since we now have a $2,000 cap on medications for Part D Medicare per year, this person should only be responsible for $2,000 of out of pocket costs. Insurance carrier will pick up the rest of the cost for the year for Part D drugs.

Answered by Scott Sims on April 9, 2025

Broker Licensed in OR, AZ, CA & 15 other states

Answered by Scott Sims Medicare Insurance Agent

Michael Andrews · Answer

If you have a prescription drug plan either through a Medicare Advantage plan or a stand alone part D plan, the most you will be responsible for is $2,000 out of pocket for the year as long as your prescriptions are in the formulary of the plan.

Answered by Michael Andrews on April 15, 2025

Broker Licensed in CT

Answered by Michael Andrews Medicare Insurance Agent

Lance Stanley · Answer

2025 Medicare prescription drug plan are now capped at $2000.00 annually. So, after you reach that amount of out of pocket cost you will not have any out of pocket cost the rest of the year.

Steven Bleicher · Answer

Greatly!! The passage of the Inflation Reduction Act last year means that the most you will spend on known Rx’s (not ones of an experimental nature) is going to be $2,000.00 which Medicare will keep track of. Bear in mind that the $6K is preposterous! This could also mean that as long as you know that a “bio similar” drug is not recommended by your doctor as a substitute, in the very 1st month, you have already surpassed the maximum out of pocket! This is going to be a boon to your expenses this year.

Answered by Steven Bleicher on April 15, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Wild Bill Anderson · Answer

We will be sure your drug is on the plans list.  As long as it is you can spend no more than $2000 a year for covered drugs.

Ryan Ross · Answer

Starting in 2025, Medicare Part D will have a $2,000 out-of-pocket cap for prescription drugs. That means no matter how expensive your medications are, like your $6,000 a month biologic medication, you won’t pay more than $2,000 total for the whole year on covered prescriptions.

This change will offer huge relief for people like you with high-cost medications. It helps make treatments more affordable and predictable, so you can focus on feeling better instead of stressing about the cost. Let me know if you’d like help reviewing your current plan or switching to one that works best with these new changes!

Sophia Davis · Answer

If your biologic is administered at a facility, this is typically billed under Medicare Part B instead of D, therefore the Inflation Reduction Act changes will have no bearing. What will help is being on a plan with a lower Max-out-of-Pocket cost.

Answered by Sophia Davis on April 21, 2025

Agent Licensed in OH

Answered by Sophia Davis Medicare Insurance Agent

Jennifer Osborne · Answer

As long as your prescription plan covers the medication, your annual maximum prescription cost will be $2,000. But, if your plan does not cover the formulary, it does not apply toward that maximum, so best to review your current plan for formulary coverage.

Answered by Jennifer Osborne on April 9, 2025

Broker Licensed in KY, FL, IL, IN, NE & OH

Answered by Jennifer Osborne Medicare Insurance Agent

Lenora Sikkenga · Answer

Beginning in 2025, the annual out-of-pocket spending cap for Part D enrollment will $2000. This includes deductibles and copays and co insurance but does not include premiums. So after the two thousand dollars has been met there is no other out of pocket expense

Answered by Lenora Sikkenga on April 14, 2025

Broker Licensed in NV

Answered by Lenora Sikkenga Medicare Insurance Agent

I have severe rheumatoid arthritis and my biologic medication costs $6,000 per month. How will the 2025 Medicare Part D changes affect someone in my situation?

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I have severe rheumatoid arthritis and my biologic medication costs $6,000 per month. How will the 2025 Medicare Part D changes affect someone in my situation?

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