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Remember, starting in 2025 the annual out of pocket cost for prescription drugs is capped at $2,000. Roughly 10 percent 0f those of us on Medicare will benefit … luckily.
But it’s good to know there is a limit.
My suggestion, build that $2,000 into your planning, just in case. Plan to set up your own Rx fund or if already retired start one now. I just like funds designated for a single purpose.
Or, if you have a HSA, that’s good too.
The $2,000 out of pocket max is $2,100 this year, so I guess it will continue to be indexed. I am not complaining as the Zanubrutinib I take costs $14,750 monthly which is up $1,000 monthly over last year.
And the $2K cap is only on certain drugs!
Applies to all drugs that are on your plans formulary.
It was political. The problem is everyone’s plan rates went up for those 10%. And in some states it has been a significant increase.
This is a significant benefit for us. We also benefited in 2024 from the elimination of copays after we reached the “catastrophic coverage” category.
Another change this year is that you can elect to have your prescription payments spread in monthly amounts over the year.
Right, I’m waiting to see how that works in practice. I haven seen the process yet. But it seems a bit tricky.
Just be aware the $2,000 cap is limited to drugs on the insurance company’s formulary.
Sadly true. The expensive drug I was taking for rheumatoid arthritis has been dropped from all but two of the plans in my area, and those two have high premiums. I believe Humira, a popular and highly advertised RA drug, has also been dropped.
You need to compare the total cost your pay for the combination of drug costs and premiums for the plan. Please go go Medicare.gov and click the drop down “Health and Drug Plans/Find Health and Drug Plans. This is the Medicare Plan Finder and may be the best thing the government has ever provided since it will provide the total costs for your specific mix of prescriptions under all available plans in your area. It even sorts the lowect cost plan on top.
Humira is a biologic, so there is no generic, but there are interchangeable biosimilar drugs such as Cyltezo, Amjevita, Hadlima, Abrilada, and Simlandi that you might ask your provider about.
Always or by law an alternative in the same class of drugs.