Medicare and State Drug Cost Caps Start January 2025

Minnesota's new law capping copays for life-saving medications, including insulin and EpiPens, at $25 monthly will take effect on January 1, 2025, potentially saving families thousands of dollars annually despite concerns from insurers about premium hikes. Concurrently, Medicare will implement a $2,000 yearly cap on out-of-pocket prescription costs starting January 1, 2025, as part of the Inflation Reduction Act, which may lower costs for millions of seniors, although it has faced Republican opposition and concerns about increased premiums. The Act's changes also include a $35 monthly cap on insulin, with Medicare beneficiaries able to spread out-of-pocket costs over the year. Meanwhile, the proposed Prescription Drug Affordability Boards (PDABs) in states like Illinois aim to negotiate drug prices to ensure affordability, a model already adopted by several states to combat high drug costs. These measures seek to reduce prescription expenses amid political debates, with some Republicans campaigning to repeal the Inflation Reduction Act, potentially affecting future Medicare policies.