Out-of-Pocket Cap Savings for Medicare Part D Enrollees

Out-of-Pocket Cap Savings by State

Thanks to the Biden-Harris Administration’s lower cost prescription drug law, some people with Part D prescription drug coverage who have high drug costs now have their out-of-pocket drug costs capped at about $3,500. This out-of-pocket cap is saving millions of people with prescription drug coverage from the burden of skyrocketing medication expenses, allowing them to focus on their health instead of their bank accounts. See how many people with Medicare in your state hit the cap in the first half of this year and will therefore pay no more in out-of-pocket costs for the rest of 2024. The full report is also available.

Source: CMS OEDA analysis of the Medicare Prescription Drug Event (PDE) and Medicare enrollment data files.
* The IRA sets the cap at $2,000 for 2025.
** Data suppressed as per CMS disclosure rules (https://resdac.org/articles/cms-cell-size-suppression-policy).
^a Total includes suppressed territory estimates and enrollees residing outside the United States.