Medicare Drug Coverage Faces Increased Restrictions, Study Finds

Recent analyses reveal growing challenges in prescription drug pricing and coverage across Medicare, Medicaid, and private insurance. The Inflation Reduction Act of 2022 allows Medicare to negotiate drug prices but imposes extended exclusivity periods for biologics, delaying potential savings despite comparable development costs and clinical value between biologics and small molecule drugs. Medicaid is under scrutiny as lawmakers consider cost-saving measures such as linking drug prices to international benchmarks, amid efforts to reduce spending while maintaining coverage for millions of low-income Americans. Concurrently, health insurance coverage is restricting access to medications more frequently, with Medicare covering fewer drugs and imposing more restrictions than commercial insurance, complicating patient access and increasing out-of-pocket costs. Distinctions between Medicare Part B and Part D drug coverage also contribute to confusion and potentially higher costs for beneficiaries depending on drug administration and plan details. These dynamics underscore the complexity and tension in balancing cost containment with access to necessary medications within U.S. public health programs.