2025 Part D Landscape Files Reveal Plans Are ‘Managing Their Risk More Carefully’

Oct 10
Oct 10, 2024

Because the Inflation Reduction Act (IRA) is making significant changes to the Medicare Part D benefit structure next year, industry watchers have been bracing for CMS’s release of the 2025 landscape files, fearing they would detail sharp premium increases for stand-alone Prescription Drug Plans (PDPs). While those fears have largely not come to fruition, experts say there is still evidence of plan sponsors subtly maneuvering to offset the risks associated with major policy shifts.

“Given all the changes in plan liability, I think we all expected really substantial changes in the cost to the consumer for Part D, so limited changes in plan premiums were a surprise,” Amanda Tripp, a principal at Avalere Health, tells AIS Health, a division of MMIT. Starting in 2025, the IRA will cap Medicare Part D beneficiaries’ out-of-pocket drug costs at $2,000 annually and change Part D plan sponsors’ cost liability past that cap to 60%, up from 20% in 2024 and 15% in 2023 and earlier.
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Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.