Explore prescription drug coverage

As part of the Inflation Reduction Act—a law aimed at providing financial relief for people with Medicare—some changes are rolling out on January 1, 2025. These changes apply to anyone with a Regence Medicare Advantage plan with prescription drug coverage. Both changes also apply only to Medicare Part D medications and not to any medications or supplies under Medicare Part B.

$2,000 yearly cap for prescription costs
You’ll have an out-of-pocket maximum of $2,000 for Part D prescription drug costs for the plan year. This is a big reduction from the previous $8,000 out-of-pocket maximum in 2024.

Part D coverage gap (“donut hole”) eliminated
In 2025, the coverage gap phase will be eliminated. The coverage gap phase (also known as the “donut hole”) previously followed the deductible and initial coverage phases, in which you’d have to cover 25% of your drugs. This coverage gap phase will no longer apply since there will be the lower $2,000 out-of-pocket maximum. Learn more about coverage phases

Tier 3 & 4 drugs changing from copay to coinsurance
Part D Tier 3 and Tier 4 drugs are changing from a copay to a coinsurance. This means that instead of paying a fixed amount for a Tier 3 or Tier 4 drug, you’ll pay a percentage of the total drug costs after you meet your deductible (if your plan includes one). This could increase your prescription drug out-of-pocket costs. Contact Pharmacy Customer Service to learn more about this benefit change.

Medicare Prescription Payment Plan
With this new payment option, you can spread your out-of-pocket costs for prescription drugs over the course of the calendar year (January-December). So rather than paying a large amount all at once, you’ll make smaller monthly payments throughout the year. While it won’t reduce your total drug costs, it can help you manage your monthly expenses.