2025 Medicare Changes ‘Much Simpler’ for Eligible Patients With Cancer

For patients with cancer who are eligible for Medicare, significant changes are coming to Medicare in 2025.

Patients who require expensive drugs may experience the benefit of a cap on out-of-pocket drugs that cost more than $2,000, meaning they won’t have to pay more than $2,000 out of pocket, explained Joanna Doran, CEO of Triage Cancer, in an interview with CURE®.

“So in 2024, this is an interim year, so these changes are coming about as a result of the Inflation Reduction Act, which was passed in 2022, so these changes are being phased in over time and they go fully into effect next year [in 2025],” Doran, also a member of the CURE® advisory board, said.

She noted that in 2024, the cap on the total out-of-pocket drug costs was $8,000. However, “if someone is taking only brand name drugs, what they actually pay out of pocket would be $3,333, so the math is a bit complicated.”

Nevertheless, Doran said “it becomes much simpler” in 2025 with the cap of $2,000.

Doran sat down with CURE® to discuss the changes approaching Medicare starting in January 2025 and what patients with cancer with Medicare should be aware of.

WATCH FULL VIDEO HERE: 2025 Medicare Changes: What Eligible Patients With Cancer Need to Know

Transcript:

For 2025, there are two very large changes to Medicare's prescription drug program, which is also referred to as Part D. That's where people purchase prescription drug coverage through a private insurance company, and they might have access to that prescription drug coverage as a standalone Part D plan that they're buying, or it might be prescription drug coverage that they have access to through their Part C Medicare Advantage plan.

And so, for either one of those options, there are some big changes coming for 2025. The first change is that really for the first time in the history of Medicare prescription drug benefits, there will be a cap on the out-of-pocket costs for prescription drugs under Part D. And the cap for 2025 is $2,000, so people won't pay more than $2,000 out of pocket for their Part D prescription drug costs in 2025, which is a significant change, because without a cap, people could end up paying tens of thousands of dollars out of pocket by the end of the year for their prescription drug costs. So that will make a big difference in the lives of people who have Medicare and have especially expensive drugs.

Transcript was edited for clarity and conciseness.

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