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Inflation Reduction Act Changes To Part D Plan Design: Lower Premiums, Higher Deductibles, And Some Smaller

David M Anderson1, Matthew McEnany2, Sarah E Petry3

  • 1David M. Anderson (da29@mailbox.sc.edu), University of South Carolina, Columbia, South Carolina.

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The Inflation Reduction Act (IRA) significantly increased Medicare Part D deductibles and reduced premiums for beneficiaries in 2025. Prescription drug plan formularies also contracted, impacting drug access.

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Area of Science:

  • Health Policy
  • Pharmaceutical Economics
  • Medicare Part D Analysis

Background:

  • The Inflation Reduction Act (IRA) of 2022 introduced significant changes to Medicare Part D prescription drug plans.
  • These changes altered the financial and risk-bearing structures for plans starting in 2025.

Purpose of the Study:

  • To evaluate the impact of the Inflation Reduction Act (IRA) on Medicare Part D plan design and beneficiary costs.
  • To compare actual 2025 outcomes with predicted trends had the IRA's benefit changes not been implemented.

Main Methods:

  • Utilized Medicare public use files from 2021-2025.
  • Constructed a counterfactual trend using 2021-2024 data to forecast 2025 outcomes without IRA changes.
  • Compared actual 2025 deductibles, premiums, and utilization management against predicted trends for Medicare Advantage prescription drug (MA-PD) and standalone prescription drug plans (PDPs).

Main Results:

  • Actual deductibles in 2025 were substantially higher than predicted: MA-PD plans averaged $305.42 (predicted $187.54) and PDPs averaged $490.56/month (predicted $401.42).
  • Premiums decreased more than predicted: MA-PD plans averaged $12.76/month (predicted $15.02) and PDPs averaged $39.55/month (predicted $64.07).
  • No significant changes were observed in prior authorization or step therapy; however, PDP formularies for protected classes and low-tier drugs shrank relative to trend.

Conclusions:

  • The Inflation Reduction Act led to higher-than-expected deductibles and smaller formularies for Medicare Part D plans in 2025.
  • While premiums decreased, the increase in deductibles and formulary contraction may offset savings for beneficiaries.
  • Utilization management metrics remained unchanged, suggesting the IRA's primary impact was on cost-sharing and formulary design.