Archived 2024: Will my Catastrophic Coverage drug costs change over the years?

In the past, yes, but your Catastrophic Coverage costs will not change in the future (they will remain $0). From 2006 through 2023, Catastrophic Coverage drug costs could increase year-to-year -- but cost-sharing in the Catastrophic Coverage phase ended December 31, 2023. For plan year 2024 and beyond, the Inflation Reduction Act (IRA) of 2022 eliminated beneficiary formulary Part D drug cost-sharing when you exceed your annual out-of-pocket spending limit (TrOOP) and enter Catastrophic Coverage.

Before the 2024 Catastrophic Coverage phase, you paid the greater of either 5% of the formulary drug's negotiated retail price - or a fixed copay (that changed annually) depending on the type of drug -- generics and preferred brand drugs that are multi-source drugs or all other drugs.

For example, back in 2023, you paid the higher of either 5% of retail prices or $10.35 for brands or $4.15 for generics in Catastrophic Coverage. Therefore, if you were using a brand-name drug with a retail cost of $100, your coverage cost in the 2023 Catastrophic Coverage phase would be $10.35 (since $10.35 is greater than $5 - or 5% of $100). But, if you were using a brand drug that has a $400 retail cost you would pay $20 (since $20 - or 5% of $400 is greater than the standard 2023 copay of $10.35).

Important Reminder: Catastrophic Coverage only applies to Medicare Part D drugs covered by your Medicare Part D plan. Catastrophic Coverage will not apply to non-Part D drugs or Part D drugs not covered by your Medicare drug plan.

The chart below shows the changes of fixed cost-sharing for the Catastrophic Coverage phase over the past years. As noted, previous to 2024, you paid the greater of the annual copay (for brands or generics) or 5% of the formulary drug's negotiated retail price - so, as retail drug prices increased, so also your Catastrophic Coverage costs increased. Click the plan year to see examples and more details for a specific year or click here to see a chart of Medicare Part D plan parameters for all years since 2006

Catastrophic Coverage Phase Cost-Sharing
Plan Year	TrOOP	Generics or Preferred Brand Drugs that are Multi-Source Drugs	All Other Drugs
2026	$2,100	not applicable	not applicable
2025	$2,000	not applicable	not applicable
2024	$8,000	not applicable	not applicable
2023	$7,400	$4.15	$10.35
2022	$7,050	$3.95	$9.85
2021	$6,550	$3.70	$9.20
2020	$6,350	$3.60	$8.95
2019	$5,100	$3.40	$8.50
2018	$5,000	$3.35	$8.35
2017	$4,950	$3.30	$8.25
2016	$4,850	$2.95	$7.40
2015	$4,700	$2.65	$6.60
2014	$4,550	$2.55	$6.35
2013	$4,750	$2.65	$6.60