I'm on an expensive specialty medication. Will the 2025 Part D changes help someone in my situation?

Question

Heather Borlenghi · Accepted Answer

Yes, the part D changes will help you. Seniors no longer will pay more than $2000 a year for any medication covered by Medicare.

Lt Col Tim Brown · Answer

In 2025 the most anyone can spend on medications in a Callander year, no matter how many medications they take is $2,000.

Michael Caldwell · Answer

If your out of annual pocket for the particular prescription is over $2,000, then yes, it should help.

Jonathan Potter · Answer

It depends on the medication that you take. If it is covered under the formulary of the company you chose then you will have a great experience. If you need to get a pre authorization then that will be a more tedious situation but it is possible to get it covered depending on how much time your doctors office wants to spend on your case to fight for the coverage of the medication.

Answered by Jonathan Potter on April 14, 2025

Broker Licensed in UT, AZ, CA & 14 other states

Answered by Jonathan Potter Medicare Insurance Agent

Carolee Turner · Answer

CMS, Centers for Medicare Services has removed the "Donut Hole" In 2025 for all stand alone Part D plans and Medicare Advantage Plans across the board. Instead of the $8000 out-of-pocket max, it is now just $2000 out-of-pocket max. This includes any deductible paid. It is best to find a local agent who can give you the monthly, quarterly and annual figure of all your drugs, including any deductible incurred. Every formulary differs and the cost reflects this, so shopping for the plan which is a best fit for you is best with a trusted local agent in your area.

Answered by Carolee Turner on May 13, 2025

Agent Licensed in FL, IL, MI, OH, SC & TN

Answered by Carolee Turner Medicare Insurance Agent

Walt Smith · Answer

If you take a namebrand drugs, that’s expensive the two 2025 out-of-pocket maximum is $2000. That should definitely help your situation.
The drug must be on the formulary of the insurance plan that you choose. Depending on the medication and depending on the plan, you may even spend less than 2000.

Mike Henry · Answer

Dependxx as on your Part D. Reason you should review it every year.  Check with your agent.   Open enrollment starts 10/25 and ends 12/7 every year

Jaye Maxx Alexander II · Answer

You must always list all your medications so that they can be checked against  the formulary for the companies with a MAPD or MA plan, with a PDP plan.

Kelly Linster · Answer

Yes you will be capped at $2000 maximum out of pocket (MOOP). One must check to make sure the medicine is on the formulary.

Wild Bill Anderson · Answer

The big change in 2025 to all Medicare Drug plans is the $2000 cap out of pocket for covered drugs The challenge is “covered”. Cheap drug plans have fewer drug “covered”. If the drug is not a covered drug you have no cal on how much you can pay out of your pocket!

Answered by Wild Bill Anderson on April 8, 2025

Broker Licensed in CA

Answered by Wild Bill Anderson Medicare Insurance Agent

Richard Balistreri · Answer

There is a maximum out-of-pocket of $2,000 for 2025. You need to make sure your medication is covered by your Part D plan so that it counts towards the deductible. After you reach the deductible, your medications should be covered for the remainder of the year without you paying anything more. This cap could provide significant financial relief to those with high medication costs.

Answered by Richard Balistreri on May 13, 2025

Agent Licensed in MO, AZ, FL & 7 other states

Answered by Richard Balistreri Medicare Insurance Agent

Fran Lovelace · Answer

It can if you find a plan where the medication in on the plan's formulary.  If it is on formulary, the maximum out of pocket is $2,000.00 in 2025.

Kevin Chaikin · Answer

First of all, it depends if the drug is covered by a Medicare Part D plan. Not all drugs are covered by all plans and formularies vary plan-to-plan. However, it if it IS covered, you will not spend more than $2,000 this year for all covered medications.

Answered by Kevin Chaikin on April 28, 2025

Broker Licensed in VA, AL, AZ & 31 other states

Answered by Kevin Chaikin Medicare Insurance Agent

Brianna Douros · Answer

The Medicare Prescription Payment Plan is a payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by your plan by spreading them across the calendar year. 

If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). 

There’s no cost to participate in the Medicare Prescription Payment Plan so this may be helpful with your expensive specialty medication.

Gregory Gudis · Answer

The changes to Part D in 2025, especially the addition of a $2,000 out-of-pocket limit, will greatly assist those who require costly specialty drugs. This change ensures that once individuals hit this maximum out of pocket, they will no longer be responsible for any further payments for covered medications for the remainder of the year.

Answered by Gregory Gudis on April 14, 2025

Broker Licensed in AZ, CO, CT & 16 other states

Answered by Gregory Gudis Medicare Insurance Agent

Lawanda Radford · Answer

Hello and Yes, the 2025 changes to Medicare Part D, especially the $2,000 out-of-pocket cap, can significantly benefit individuals taking expensive specialty medications. This cap limits the total amount you pay out-of-pocket for covered prescription drugs, meaning you won't have to pay more than $2,000 for the entire year, regardless of how expensive your medication is.

Answered by Lawanda Radford on May 17, 2025

Agent Licensed in GA, AZ, FL & 10 other states

Answered by Lawanda Radford Medicare Insurance Agent

Ceranes Lejulus · Answer

The 2025 Part D changes are likely to help with the specialty medication. Primarily, there is Medicare Prescription Payment Plan --- which is a voluntary payment option for managing out-of-pocket prescription drug costs, allowing a beneficiaries to spread payments across the year instead of paying the pharmacy directly.

Secondly, beneficiaries no longer have to deal with the donut hold / coverage gap... which is a sigh of relieve for many beneficiaries.

Gus Kinnie · Answer

Starting in 2025, there will be a yearly limit of $2,000 on how much you have to pay out of your own pocket for your Part D covered drugs. If your specialty medication costs a lot, you could reach this limit and then not have to pay any more for your covered drugs for the rest of the year.

Answered by Gus Kinnie on April 11, 2025

Agent Licensed in IN, CA, IA & 6 other states

Answered by Gus Kinnie Medicare Insurance Agent

I'm on an expensive specialty medication. Will the 2025 Part D changes help someone in my situation?

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I'm on an expensive specialty medication. Will the 2025 Part D changes help someone in my situation?

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