In the past, yes, but not in the future. In the past, Catastrophic Coverage drug costs increased year-to-year -- but cost-sharing in the Catastrophic Coverage phase will end December 31, 2023.
In
the
2023 Catastrophic Coverage phase, you will pay 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,
in 2023, you pay the higher of either 5% of retail prices or $10.35 for brands or $4.15 for generics in Catastrophic Coverage.
But 2023 is the last year that Medicare Part D
beneficiaries will pay cost-sharing in the Catastrophic Coverage phase.
For plan year
2024 and beyond, the
Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing in the Catastrophic Coverage phase.
The chart below shows the fixed cost-sharing for the Catastrophic Coverage phase over the past years. As noted, you pay 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 increase, so also can your Catastrophic Coverage costs increase.
For example in 2023, if you are using a brand-name drug with a retail cost of $100, your coverage cost in the 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 now 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).
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 |
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 |