Be­yond the IRA: Re­search points to need for even low­er co­pay caps for some Part D ben­e­fi­cia­ries

As a re­cent PhRMA analy­sis shows, the cost of fill­ing a pre­scrip­tion can add up, and lead to non­ad­her­ence or worse. For pa­tients fill­ing a brand-name pre­scrip­tion drug in the de­ductible (be­fore the in­sur­ance kicks in), pa­tients paid eight times more, on av­er­age, for their med­i­cine than a pa­tient fill­ing a brand pre­scrip­tion with a co­pay.

To help se­niors at the phar­ma­cy counter, be­gin­ning in 2025, Pres­i­dent Biden’s sig­na­ture In­fla­tion Re­duc­tion Act (IRA) will es­tab­lish a cap on out-of-pock­et costs for many se­niors at $2,000 an­nu­al­ly, and a $35 month­ly cap for in­sulin — mea­sures like­ly to sig­nif­i­cant­ly help many, in­clud­ing those who are cur­rent­ly shoul­dered with an­nu­al pre­scrip­tion costs ex­ceed­ing $10,000.

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