Specialty Tier Cost Sharing Thresholds: Annually, CMS sets the maximum allowable cost sharing for the specialty tier based on the plan’s deductible, in accordance with § 423.104(d)(2)(iv)(D).

Beneficiary will remain in the Catastrophic Benefit Period through Dec. 31, 2025. Part D benefit will reset on Jan. 1, 2026, starting again with a deductible.

Jul 16, 2025 · This brief analyzes Medicare Part D enrollment and costs in 2025 and trends over time, based on data from the Centers for Medicare & Medicaid Services (CMS).

Jun 19, 2025 · To assess these changes, our analysis focused on deductibles, tier-level cost sharing and tier placement of drugs with high Part D spending. Additionally, we compared trends between …

Nov 14, 2024 · Part D premiums vary by plan and, regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security …

Jul 16, 2025 · For specialty tier drugs, coinsurance will also be the norm, with median rates fluctuating between 25% and 33%.This indicates a growing reliance on percentage-based cost-sharing for …

Aug 19, 2024 · Specialty Tier Cost Sharing Thresholds: CMS will establish new cost-sharing methodologies for specialty tiers to reflect the redesigned Part D benefit. For CY 2025, coinsurance …

May 9, 2025 · Medicare Part D plans categorize prescription drugs into different tiers, with each tier having varying costs, to help beneficiaries manage expenses. Lower tiers, like the generic tier,...

Sep 15, 2025 · As changes to Medicare Part D prescription drug coverage have taken effect with implementation of the Inflation Reduction Act (IRA), concurrent changes in plan design have …

Apr 1, 2024 · As such, CMS has included a new methodology in the Final Program Instructions to determine the specialty tier coinsurance/deductible ranges under the redesigned Part D benefit.