In 2024 Medicare announced there would be a $2000 drug cap for Medicare patients. In the current political climate, big pharma helps run the government. So as always, the devil is in the details. It turns out there are two important qualifications to be met in order to be protected by this “cap”. First, you must have Medicare Part D, a drug plan. Second, your drug must be covered by the plan.
Unfortunately with the exorbitant prices charged by big pharma for the new drugs we all see advertised on TV and the Internet, the insurance companies often avoid covering them.
If the drug is not covered, the $2000 drug cap reverts to the Medicare standard drug coverage. Let’s say a drug like Mounjaro costs $1000 per month. You first pay a deductible of $590. After that you pay 25% of the cost which is $250 per month, until you reach $8000 total. At this point a “nominal” charge is made for totals exceeding this $8000 limit. So in this case it would take over one year to reach $8000, so the “nominal”charge would not kick in. The total cost would be $3340.00. (quite a bit more than what the news led us to believe)
