Arielle Elliott, Research Manager – 

The Medicare prescription drug market has undergone significant changes over the last three years, and likely much more change is still to come. With the passage of the Inflation Reduction Act in late 2022, particularly the establishment of the drug price negotiation program for 10 high-cost, single-source brand prescriptions, in combination with the introduction of the $2,000 cap on out-of-pocket spending, seniors who were aware of the Act tended to expect their drug costs to decrease in the coming years.

Now that we have arrived in 2025 and have seen the implementation of both these policies, we can compare the drug costs for a series of types of prescription drug users to quantify the extent of prescription cost savings as a result of the IRA. So, have seniors overall seen reductions to their drug spend? In particular, how have these policy changes impacted users of the price-negotiated brand drugs?

First, a disclaimer: Drug costs are highly individualized and vary substantially based on plan, state, medications used, and number of medications required. With this being said, we will compare based on the most widely used of the price-negotiated medications and then compare users of commonly used generic medications of varying quantities. These cost comparisons are based on the top five largest plans in the state of Florida, as a representative example, to provide a sense of the cost changes between 2023 and 2025.

Eliquis, a blood thinner, is the most widely used of the 10 medications that were price negotiated. In 2022, about 3.5 million Part D enrollees filled prescriptions for Eliquis.¹ By 2024 sales for Eliquis increased by 9% from the previous year, generating $13.3 billion in sales.² In 2023, for a user of 5 MG daily of Eliquis, the cost based on the average cash price from the largest standalone Part D plans was $612.13 for a 30-day supply.³ In 2025 for the same amount, the average monthly cost would be $587.76.⁴ To put this in yearly costs, an uninsured senior in Florida would be paying a retail price of $7,345.56 in 2023. For 2025, the yearly retail cost of Eliquis would be $7,063.12. To provide another example among drugs that were price-negotiated, Jardiance was the second-most widely used drug on the price negotiated list, with 1.6 million users as of 2023. In 2023 the average monthly cost for 10 MG was $639.21, while the 2025 average monthly cost for the same amount dropped to $571.53.

While we see here that the impact on the retail prices was substantial, how does this translate to what seniors are actually paying for these drugs with their coverage? For plans that had Eliquis as a copayment, the average 2023 cost was $39.56. For those that had it as a coinsurance, the average cost was $133.00. Meanwhile in 2025, the average Eliquis copay cost was $46, while the average coinsurance cost was $117.75. Alternatively, for Jardiance neither cost-shares have seen reductions, with the average cost of coinsurances remaining the same in recent years — $113.98 in 2025 and $111.86 in 2023. Copay amounts have also not been significantly affected. So while the cost has been reduced, the spending cap may have a larger impact on seniors’ overall drug costs than a reduction in the cost shares for the drug itself.

2023

2025

Beyond price-negotiated drugs, how did lower-cost generic prescription prices fare between 2023 and 2025? We compare in the table above the cost of Caduet, the generic option for Lipitor — one of the most widely used prescriptions today. The impact is most overt on the retail price, but even the already low-cost shares have been slightly reduced in the last two years.

So did drug negotiations and the $2,000 Rx cap benefit today’s seniors? For those with the highest drug costs: yes, no doubt. Users of high-cost, single source brand drugs, regardless of whether they were on the price negotiations list or not, will have benefited substantially from the $2,000 cap as a yearly supply of these drugs exceed the cap by a long margin, even more so for users of multiple high-cost drugs.

For the majority of seniors, however, who do not generally spend $2,000 or even near it on their prescription costs, such as users of primarily generic prescriptions, the $2000 cap would likely provide no reduction to their costs. In fact, for this segment it may have resulted in increased costs as drug deductibles have widely increased as an adjustment to the cap.⁵ The average MAPD drug deductible has increased by $165 since 2024, while the average standalone PDP deductible has similarly gone up since then by $64.⁵

Among Medicare Advantage members who have used their coverage so far in 2025, 12% expressed that they’ve had their prescription costs increase.⁶ Ultimately, while the costs of some prescriptions — particularly those on the price negotiations list — may have decreased, the impact of the price negotiations on seniors’ drug costs appears to be less dramatic than people may have initially hoped. It appears that the price negotiations will have a greater positive impact on the Medicare Trust Fund more so than the seniors today.

Citations

¹ASPE Assistance Secretary for Planning and Evaluation, Fact Sheet “Inflation Reduction Act Research Series- Eliquis: Medicare Enrollee Use and Spending”. https://aspe.hhs.gov/sites/default/files/documents/d1e51e1f27136349e9a48677d14c5198/Eliquis.pdf

²Verified Market Research. “Eliquis Market Size and Forecast”. https://www.verifiedmarketresearch.com/product/eliquis-market/

³Q1 Medicare.com “2023 Drug Finder Tool”. https://q1medicare.com/PartD-2023-SearchPDPMedicareDrugFinder.php#results

⁴Q1 Medicare.com “2025 Drug Finder Tool.” https://q1medicare.com/PartD-SearchPDPMedicarePartDDrugFinder.php#results

⁵Deft Research MAPD and PDP Disruption Tool.

⁶Deft Research, “2025 Medicare Member Onboarding Study.”