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

Question

Lt Col Tim Brown · Accepted Answer

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

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

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

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.

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

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.

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.

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.

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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