With new caps, Wisconsin Medicare enrollees expected to save $1500 next year

(Public News Service) – Older Wisconsin residents struggling to manage prescription drug costs, have new data on how much they might save as a new federal rule kicks in early next year.

The Inflation Reduction Act, signed into law two years ago, includes several provisions designed to address affordability issues for people needing medications.

Most of the changes are meant to help Medicare enrollees. Starting January 1, the new rule will cap out-of-pocket drug costs at $2,000 annually for those under Medicare’s Part D.

David Bowen, advocacy director for AARP Wisconsin, detailed the estimated savings.

“Medicare drug plan enrollees nationwide, who reach the new out-of-pocket cap,” said Bowen, “will see an average savings of roughly $1,500, or 56%, in 2025.”

At the state level, the analysis predicts these savings will benefit nearly 50,000 Wisconsinites next year.

Other IRA provisions have already kicked in, including a $35 cap on monthly insulin costs for Medicare recipients. Drug makers have criticized these changes, arguing they will hurt innovation.

Bowen said the pending out-of-pocket changes mean older people dealing with health issues, such as diabetes, will get much-needed relief when refilling their prescriptions.

Collectively, he said these moves should get to the core of the cost issue consumer advocates have been talking about for years.

“We have older Wisconsinites that are choosing either limiting their supply of their prescriptions,” said Bowen, “or they literally are taking resources that are used to pay for other essentials to sometimes cover the cost.”

Last month, the Biden administration unveiled price-reduction agreements for the first group of Medicare-covered drugs included in negotiations with manufacturers.

The lower cost of those drugs takes effect in 2026.

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