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Updated: Apr 16, 2026

Watershed Planning within a Quantitative Scenario Analysis Framework

Watershed Planning within a Quantitative Scenario Analysis Framework

Published on: July 24, 2016

The changing Part D landscape.

Geoffrey Joyce^1,2, Beier Chen², Barbara Blaylock³

¹Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA 90089, United States.

Health Affairs Scholar

|April 15, 2026

Summary

This summary is machine-generated.

Medicare Part D plan options are consolidating, with fewer choices for beneficiaries. Changes in financing and drug formularies may impact access and affordability, especially for traditional Medicare users.

Keywords:

Formulary design Formulary exclusions Medicare advantage Medicare part D Plan consolidation

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Area of Science:

Health Economics
Pharmaceutical Policy
Medicare Part D Analysis

Background:

Medicare Advantage Prescription Drug (MA-PD) and stand-alone Prescription Drug Plans (PDPs) have different financing structures.
The Inflation Reduction Act (IRA) introduced changes affecting plan and manufacturer cost-sharing and government reinsurance.
These financial shifts may influence the range of coverage options available to beneficiaries.

Purpose of the Study:

To compare coverage options across MA-PDs and PDPs using cost-sharing categories.
To analyze trends in plan designs and drug formulary exclusions from 2020 to 2025.
To assess the impact of evolving Part D marketplace dynamics on beneficiaries.

Main Methods:

Utilized 2020-2025 data from CMS public use files.
Compared plan types (MA-PDs, enhanced PDPs, basic/AE PDPs) based on mean premium and deductible.
Examined drug formulary exclusions for brand-only drugs in unprotected classes.

Main Results:

MA-PDs largely maintained low-premium/low-deductible designs, supported by integrated medical benefits.
Enhanced PDPs increasingly shifted towards low-premium/high-deductible structures.
Basic/AE PDPs predominantly featured high-premium/high-deductible designs.
By 2025, over half of brand-only drugs in unprotected classes were excluded from Part D formularies across all plan types, particularly in high-cost therapeutic areas.

Conclusions:

The Part D landscape shows increasing plan consolidation and reduced diversity.
These trends may negatively affect access and affordability for traditional Medicare beneficiaries.
Policymakers should evaluate subsidy and risk-adjustment mechanisms to foster competition and equitable access.