- 922
2024 Medicare Part D benefit improvements from the Q1 Newsletter attached.
1. No cost-sharing in the 2024 Catastrophic Coverage phase.
The most important 2024 change may be that a person with high prescription drug costs will not have any additional cost-sharing for formulary drugs once the $8,000 out-of-pocket spending threshold (TrOOP) is exceeded. In effect, the TrOOP threshold becomes the maximum limit or cap on Part D out-of-pocket drug spending (RxMOOP), similar to the Medicare Advantage plan Part A and Part B out-of-pocket spending threshold MOOP).
Question
Does this mean a person has to actually spend $8,000 before they have no additional costs for the remainder of the year?
Not in all cases.
The actual amount you spend will depend on your mix of generic and brand-name drugs. For example, if you purchase all brand-name drugs, your actual costs should be around$3,333. If you use the CMS estimated mix of generics and brand-name drugs, your actual costs should be around $3,429 (92.59% brand drugs and 7.41% generic drugs).
More in the attachment below:
1. No cost-sharing in the 2024 Catastrophic Coverage phase.
The most important 2024 change may be that a person with high prescription drug costs will not have any additional cost-sharing for formulary drugs once the $8,000 out-of-pocket spending threshold (TrOOP) is exceeded. In effect, the TrOOP threshold becomes the maximum limit or cap on Part D out-of-pocket drug spending (RxMOOP), similar to the Medicare Advantage plan Part A and Part B out-of-pocket spending threshold MOOP).
Question
Does this mean a person has to actually spend $8,000 before they have no additional costs for the remainder of the year?
Not in all cases.
The actual amount you spend will depend on your mix of generic and brand-name drugs. For example, if you purchase all brand-name drugs, your actual costs should be around$3,333. If you use the CMS estimated mix of generics and brand-name drugs, your actual costs should be around $3,429 (92.59% brand drugs and 7.41% generic drugs).
More in the attachment below:
