CLL Society recently held a webinar, Your Medicare Guide: Tackling Costs and Answering Your Questions, about upcoming changes coming to Medicare and Medicare Advantage plans in 2025.
During the webinar, we cautioned attendees that in response to a new out-of-pocket (OOP) cap for patients set to begin in 2025, Part D plans and MA-PDP plans (offered by Medicare Advantage) may raise patients’ premiums and change formularies that patients may have relied on this year. We urged patients to:
- check the Medicare Plan Finder website for details, as plans may have changed, and
- follow CLL Society for further updates.
Seniors enrolling in Part D plans can now expect their premiums to be stable and maybe even slightly decline in 2025.
The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program, has finalized a new and voluntary “premium stabilization demonstration” program since CLL Society’s webinar was held in September. Although this new program is voluntary, CMS is reporting that Part D plans are widely participating in this voluntary program (792 out of 818 Part D plans).
The demonstration is for stand-alone Part D plans only and includes three elements:
- A $15 uniform reduction in the base beneficiary premium
- A year-over-year premium increase limit of $35 on a plan’s total Part D premium
- A change to the risk corridors
NOTE: This demonstration program does not affect premiums of Medicare Advantage plans with prescription drug coverage (MA-PDP plans). During the webinar, we referred to these as Part C or Medicare Advantage plans, which are MA-PDP plans.
It remains important for patients to check their Part D and MA-PDP plan’s formularies change in 2025 before enrolling. That is, will some drugs be required to be taken first before the ones specifically prescribed? Will this “tier placement” change one’s copay for the same drug one was taking this year? Will prior authorization now be required even if it was not this year?
CMS has stated it has seen “no significant decreases in formulary inclusion or changes to tier placement of drugs” and that “prior authorization and step therapy rates are stable between CY 2024 and CY 2025,” but the Agency is looking across all plans in the aggregate, and not any one plan in which a patient will enroll. It’s important to check for these details and changes when choosing your specific plan for 2025.
Continue to follow CLL Society for further updates.
