Medicare Part D

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Medicare Part D is Medicare’s prescription drug program that went into effect on January 1, 2006.  Participation in Medicare Part D is voluntary, although most beneficiaries choose to enroll.  Medicare Part D beneficiaries have a choice of either a stand-alone prescription drug plan (PDP) with a separate premium or a Medicare Advantage plan with an attached drug benefit (MA-PDP). A highly popular program, Part D provides seniors and other Medicare beneficiaries with coverage of a wide range of brand-name and generic prescriptions. Medicare beneficiaries are often obligated to pay co-payments for certain drugs, although some medications (often low-cost generic drugs) may require no co-pay at all. In addition, beneficiaries with high drug expenses may find themselves temporarily in the Medicare coverage gap (also known as the “donut hole”), although the ACA takes steps to eliminate the gap over the next several years.

Prior to the advent of Medicare Part D, about one in three Medicare beneficiaries lacked prescription drug coverage. Those beneficiaries had to either go without needed medicines or pay cash prices at pharmacies far in excess of what those individuals with insurance coverage paid.

Medicare Part D is unique in that it is a federal health program whose costs and premiums have come in lower than originally forecast while still maintaining broad choice and access. Numerous experts have ascribed the program’s success to its market-driven model, plan emphasis on promoting access to more affordable generic medicines, and health plans’ ability to bargain effectively with pharmacies and brand-name drugmakers to drive deep discounts for seniors. 

Latest Resources

Innovations in Medication Therapy Management

This report describes trends in the medication therapy management (MTM) programs being conducted by America’s health insurance plans and provides details about 16 companies’ MTM initiatives for a variety of patient populations. 

Research | Center for Policy and Research | 12/17/2013

AHIP Statement on New Survey Showing 90 Percent of Seniors Satisfied with Prescription Drug Coverage

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni released the following statement in response to a new survey released today by Medicare Today and KRC Research which found that 90 percent of seniors are satisfied with their Medicare prescription drug coverage.

Press Releases | Strategic Communications | 10/03/2012

Seniors' Opinions About Medicare Rx: 7th Year Update - [PDF]

This annual survey conducted by KRC Research and Medicare Today tracks seniors' views toward the Medicare Part D program.

Reports/Research/White Papers | Strategic Communications | 10/03/2012

AHIP Statement on Affordable Prescription Drug Coverage for Seniors

America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni released the following statement today in reaction to the announcement by CMS that Medicare Part D premiums in 2013 will remain steady for the third straight year.

Press Releases | Strategic Communications | 08/06/2012

AHIP Statement on More Affordable Prescription Drug Coverage for Seniors

America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni released the following statement today in reaction to the announcement by CMS that Medicare Part D premiums for 2012 have declined slightly from 2011.

Press Releases | Strategic Communications | 08/04/2011