Insights

On April 3, 2017, CMS issued an announcement and press release relating to Medicare Part D benefit parameters for 2018. As background, employer plan sponsors that offer prescription drug coverage to Part D-eligible individuals must disclose to those individuals and to CMS whether the prescription plan coverage is creditable (as compared to Part D coverage).

In the announcement, CMS released the following parameters for the defined standard Medicare Part D prescription drug benefit, which will assist plan sponsors in making that determination:

• Deductible: $405 (a $5 increase from 2017)
• Initial coverage limit: $3,750 (a $50 increase from 2017)
• Out-of-pocket threshold: $5,000 (a $50 increase from 2017)
• Total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are not eligible for the coverage gap discount program: $7,508.75 (a $83.75 increase from 2017)
• Estimated total covered Part D spending at the out-of-pocket expense threshold for beneficiaries who are eligible for the coverage gap discount program: $8,417.60 (a $346.44 increase from 2017)
• Minimum copayments under the catastrophic coverage portion of the benefit:
  • $3.35 for generic/preferred multi-source drugs (a 5-cent increase from 2017)
  • $8.35 for all other drugs (an 10-cent increase from 2017)

Announcement »
Press Release »