Prescription Drugs bundled or standalone

The IRA lowered the cost of insulin down to $35, and lowered catastrophic coverage from $8,000 down to $2,000 in 2025. In doing so they got rid of the infamous "Donut Hole" where a portion of our population paid a whopping 25% of the retail cost of their drugs. 

Besides paying a monthly premium, some plans will charge a deductible, or at least a deductible on their more expensive Tiered drugs.  

In 2025, there will be three stages of drug coverage:

Annual Deductible Stage: Your deductible may be different from the declared federal amount, or waived entirely. The deductible for 2025 is $590. You will pay discounted price for your medications until the deductible is met. Once the deductible is satisfied, you will begin the "Initial Coverage Stage". If there is a deductible, it is typically on Tiers 3, 4, and 5. Many plans do not have a deductible. 

Initial Coverage Stage (Copay Stage): After your deductible is paid then you only share the cost based on your plan's formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copay amount that you are responsible to pay. A Tier 1 drug may cost $0; a Tier 2 may cost you $5. It is typically separated by generic drugs versus brand name drugs and then, finally, specialized medications. In 2025, the Initial Coverage cap is $2,000. After you have paid this out of your pocket (sometimes in combination with your plan), then you will reach the Catastrophic stage. 

Catastrophic Coverage:  Once your out-of-pocket spending hits the $2,000 threshold, you enter the catastrophic coverage phase. In this stage, you pay $0 for covered Part D drugs for the remainder of the calendar year.