Pioneer study: Medicare seniors paid more for some drugs in 2025

By AI, Created 10:13 AM UTC, May 20, 2026, /AGP/ – A new Pioneer Institute analysis says many Medicare beneficiaries saw higher out-of-pocket costs in 2025 for drugs targeted by the Inflation Reduction Act, even before federal negotiated prices take effect. The study says plan design, PBM practices and market changes, not direct government price setting, largely drove what patients paid.

Why it matters: - The Inflation Reduction Act was designed to lower drug costs for Medicare seniors, but the Pioneer Institute study says many patients paid more at the pharmacy counter in 2025. - The findings suggest federal price negotiation does not automatically translate into lower out-of-pocket costs for beneficiaries. - The results also point to continued pressure on Medicare Part D plan design, pharmacy benefit managers and access rules as the new pricing system rolls out.

What happened: - Pioneer Institute released a study on May 7, 2026, examining the first group of drugs selected for the Inflation Reduction Act’s Medicare price negotiation program. - The analysis found higher out-of-pocket costs in 2025 for many seniors taking widely used Medicare drugs. - The drugs studied include Eliquis, Entresto and Ibrance. - Federally set Maximum Fair Prices do not begin until 2026 and 2027, so the 2025 changes happened before negotiated prices took effect. - The study says patients can still face higher pharmacy costs depending on how health plans and PBMs structure benefits.

The details: - Eliquis is a blood thinner used to prevent strokes and treat blood clots. - Entresto is a leading treatment for heart failure. - Ibrance is a commonly prescribed therapy for breast cancer. - Insulin was excluded from the analysis because Congress separately capped insulin out-of-pocket costs. - The study says most Medicare beneficiaries historically do not reach the IRA’s $2,000 annual out-of-pocket cap. - In 2021, average annual out-of-pocket spending for non-low-income-subsidy beneficiaries was about $463, meaning the cap mainly helps a smaller group of high-cost patients. - The analysis found that more prescriptions carried no out-of-pocket cost in 2025, but that change reflected plan design shifts rather than a uniform price cut. - Out-of-pocket costs varied sharply across PBMs. - Drugs with lower out-of-pocket costs were often affected by outside market forces such as new generic or biosimilar competition or voluntary manufacturer price cuts.

Between the lines: - The study argues that the IRA is already changing incentives in Medicare Part D before negotiated prices begin. - Changes in 2025 reflect a redesigned benefit structure, the new $2,000 cap and shifting financial responsibility for insurers and PBMs. - The report says PBMs may try to offset lower revenue from negotiated drugs through higher cost-sharing, tighter restrictions or tougher concession demands elsewhere in the market. - The Congressional Budget Office has projected the IRA’s drug pricing provisions could reduce incentives to develop new medicines, adding a longer-term access and innovation concern.

What’s next: - Pioneer Institute said it will keep tracking out-of-pocket costs, formulary changes and access restrictions as IRA price setting takes effect in 2026 and 2027. - The institute also said it has fact sheets for patients and policymakers available at more information. - The study says continued monitoring will be important as the IRA’s price setting and related provisions move into full implementation.

The bottom line: - The IRA may lower federal drug prices, but this study says Medicare patients can still pay more at the point of sale depending on how plans and PBMs respond.