Center for American Progress

Project 2025 Prescription Drug Plan Would Increase Costs for as Many as 18.5 Million Seniors and Others With Medicare
Article

Project 2025 Prescription Drug Plan Would Increase Costs for as Many as 18.5 Million Seniors and Others With Medicare

If Project 2025 is implemented, at least 1.5 million Medicare beneficiaries with high out-of-pocket costs will pay more for prescription drugs next year.

Part of a Series
Empty pill bottles are scattered on the sidewalk during a protest.
Empty pill bottles are scattered on the sidewalk during a protest against high prescription drug costs in front of the U.S. Department of Health and Human Services building in Washington, D.C., on October 6, 2022. (Getty/Anna Moneymaker)

This article is part of a series from the Center for American Progress exposing how the sweeping Project 2025 policy agenda would harm all Americans. This new authoritarian playbook, published by the Heritage Foundation, would destroy the 250-year-old system of checks and balances upon which U.S. democracy has relied and give far-right politicians, judges, and corporations more control over Americans’ lives.

Over the past two years, seniors and other Medicare enrollees have begun to benefit from monumental prescription drug price reforms thanks to the Inflation Reduction Act of 2022. However, these lifesaving policies are now under threat.

The Heritage Foundation has outlined a sweeping, far-right policy vision to put power—and profits—back in pharmaceutical companies’ hands. Project 2025’s “Mandate for Leadership: A Conservative Promise” calls for repealing the Inflation Reduction Act. Similarly, the Republican Study Committees “Fiscal Sanity to Save America” fiscal year 2025 budget proposal calls for a full repeal of the law. If Project 2025 is implemented, millions of Medicare enrollees will see their out-of-pocket costs for prescription drugs rise, reversing much-needed savings generated by the Inflation Reduction Acts Medicare Part D reforms and other provisions.

What’s at stake in the Inflation Reduction Act?

The Inflation Reduction Act of 2022 took historic steps toward making drug prices more affordable for older adults and other Medicare enrollees through several important policy changes:

1. The Inflation Reduction Act redesigned elements of the Medicare Part D drug benefit to lower costs for enrollees, including by:

a. Capping annual out-of-pocket drug costs for Medicare Part D enrollees at $2,000 beginning in 2025: As a first step, the Inflation Reduction Act established an effective cap of roughly $3,300 for 2024 by eliminating cost-sharing during what was the “catastrophic coverage” phase for Part D enrollees.

b. Allowing enrollees to spread out their total annual Medicare Part D out-of-pocket costs over the course of the year

c. Capping out-of-pocket insulin costs at $35 per month

d. Eliminating out-of-pocket costs for all recommended routine adult vaccines

e. Fully expanding the low-income subsidy (LIS) program—known as “Extra Help”—to people with limited resources who earn less than 150 percent of the federal poverty level

f. Eliminating the Medicare Part D coverage gap phase and restructuring Part D discount programs

2. For the first time, the Centers for Medicare and Medicaid Services (CMS) is negotiating prices for some of the most expensive and highly utilized prescription drugs. CMS announced the first 10 drugs selected in August 2023. These drugs are currently undergoing price negotiation; the maximum fair prices will be published by September 2024 and will take effect in January 2026. Up to 80 drugs will undergo negotiation by 2030, with a subset of drugs phased in each year.

3. CMS now requires drug companies to pay rebates to Medicare if they hike drug prices above the inflation rate.

Note: This out-of-pocket cost analysis considers the impact of losing the Medicare Part D redesign provisions detailed in 1a–f above.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Across the United States, more than 1.5 million Medicare Part D enrollees—who are among the most vulnerable enrollees with significant health needs—could see their 2025 out-of-pocket costs rise if the $2,000 out-of-pocket cap is repealed. But beyond that, 18.5 million Medicare Part D enrollees could lose much-needed out-of-pocket savings from the Inflation Reduction Acts full package of Medicare Part D redesign elements (as detailed in 1a–f under “What’s at stake in the Inflation Reduction Act”). Some seniors could see an average of nearly $400 in lost drug savings in 2025 alone. Overall, Medicare Part D enrollees across the nation could lose out on up to $7.4 billion in out-of-pocket savings next year.

Use the toggle function below to see how Project 2025 could increase costs for Medicare Part D enrollees in your state.

HOW IRA REPEAL COULD IMPACT MEDICARE PART D ENROLLEES IN 2025, BY STATE

  • United States (choose a state)

1.54M

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

18.57M

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$399

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$7.4B

Total missed savings for Part D enrollees in United States

23K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

366.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$360

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$132M

Total missed savings for Part D enrollees in Alabama

1K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

30.5K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$309

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$9.4M

Total missed savings for Part D enrollees in Alaska

33K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

388.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$379

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$147.5M

Total missed savings for Part D enrollees in Arizona

14K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

203.2K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$342

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$69.5M

Total missed savings for Part D enrollees in Arkansas

122K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

2.18M

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$296

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$644.4M

Total missed savings for Part D enrollees in California

21K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

220K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$451

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$99.3M

Total missed savings for Part D enrollees in Colorado

20K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

255.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$368

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$94.1M

Total missed savings for Part D enrollees in Connecticut

6K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

63.4K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$449

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$28.4M

Total missed savings for Part D enrollees in Delaware

2K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

33.2K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$184

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$6.1M

Total missed savings for Part D enrollees in District of Columbia

120K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

1.48M

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$401

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$593.4M

Total missed savings for Part D enrollees in Florida

47K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

589.3K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$395

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$232.8M

Total missed savings for Part D enrollees in Georgia

4K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

82.1K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$281

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$23.1M

Total missed savings for Part D enrollees in Hawaii

8K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

82.2K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$462

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$37.9M

Total missed savings for Part D enrollees in Idaho

61K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

597.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$433

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$258.7M

Total missed savings for Part D enrollees in Illinois

41K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

385.7K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$465

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$179.4M

Total missed savings for Part D enrollees in Indiana

23K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

163.7K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$525

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$85.9M

Total missed savings for Part D enrollees in Iowa

19K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

129.6K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$550

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$71.3M

Total missed savings for Part D enrollees in Kansas

24K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

333.6K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$359

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$119.8M

Total missed savings for Part D enrollees in Kentucky

20K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

327.1K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$320

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$104.7M

Total missed savings for Part D enrollees in Louisiana

7K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

126.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$298

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$37.8M

Total missed savings for Part D enrollees in Maine

22K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

285K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$388

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$110.6M

Total missed savings for Part D enrollees in Maryland

27K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

481.7K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$333

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$160.5M

Total missed savings for Part D enrollees in Massachusetts

43K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

672.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$356

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$239.5M

Total missed savings for Part D enrollees in Michigan

28K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

234.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$483

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$113.5M

Total missed savings for Part D enrollees in Minnesota

17K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

203.3K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$364

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$74.1M

Total missed savings for Part D enrollees in Mississippi

36K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

348.3K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$462

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$160.9M

Total missed savings for Part D enrollees in Missouri

6K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

54K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$461

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$24.9M

Total missed savings for Part D enrollees in Montana

14K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

88.6K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$630

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$55.8M

Total missed savings for Part D enrollees in Nebraska

12K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

143K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$434

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$62M

Total missed savings for Part D enrollees in Nevada

8K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

723K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$490

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$35.8M

Total missed savings for Part D enrollees in New Hampshire

50K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

473.4K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$520

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$246M

Total missed savings for Part D enrollees in New Jersey

6K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

125.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$273

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$34.3M

Total missed savings for Part D enrollees in New Mexico

82K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

1.15M

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$390

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$446.3M

Total missed savings for Part D enrollees in New York

57K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

662.6K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$406

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$268.9M

Total missed savings for Part D enrollees in North Carolina

5K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

33.1K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$506

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$16.7M

Total missed savings for Part D enrollees in North Dakota

67K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

687.4K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$451

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$310.2M

Total missed savings for Part D enrollees in Ohio

24K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

206K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$452

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$93.2M

Total missed savings for Part D enrollees in Oklahoma

23K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

224.1K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$388

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$87.1M

Total missed savings for Part D enrollees in Oregon

76K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

829.8K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$467

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$387.3M

Total missed savings for Part D enrollees in Pennsylvania

5K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

68.1K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$340

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$23.1M

Total missed savings for Part D enrollees in Rhode Island

32K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

335K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$435

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$145.6M

Total missed savings for Part D enrollees in South Carolina

7K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

39.7K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$587

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$23.3M

Total missed savings for Part D enrollees in South Dakota

39K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

459.3K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$417

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$191.7M

Total missed savings for Part D enrollees in Tennessee

110K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

1.32M

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$400

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$528.9M

Total missed savings for Part D enrollees in Texas

10K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

96K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$491

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$47.1M

Total missed savings for Part D enrollees in Utah

4K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

44K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$492

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$21.7M

Total missed savings for Part D enrollees in Vermont

37K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

390.4K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$441

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$172M

Total missed savings for Part D enrollees in Virginia

30K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

344.5K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$413

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$142.3M

Total missed savings for Part D enrollees in Washington

8K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

140.5K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$346

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$48.7M

Total missed savings for Part D enrollees in West Virginia

31K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

298.8K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$475

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$141.9M

Total missed savings for Part D enrollees in Wisconsin

4K

Estimated number of Medicare Part D enrollees who could pay more without $2,000 out-of-pocket (OOP) cap

21.9K

Estimated number of Medicare Part D enrollees who could pay more without IRA OOP savings

$608

Average potential increase in OOP costs among Medicare Part D enrollees with OOP cost increases

$13.3M

Total missed savings for Part D enrollees in Wyoming

Sources: Juliette Cubanksi, Tricia Neuman, and Anthony Damico, "Millions of People with Medicare Will Benefit from the New Out-of-Pocket Drug Spending Cap Over Time" (San Francisco: KFF, 2024), available at https://www.kff.org/medicare/issue-brief/millions-of-people-with-medicare-will-benefit-from-the-new-out-of-pocket-drug-spending-cap-over-time/; Bisma A. Sayed and others, "Inflation Reduction Act Research Series: Medicare Part D Enrollee Out-Of-Pocket Spending: Recent Trends and Projected Impacts of the Inflation Reduction Act" (Washington: Office of the Assistant Secretary for Planning and Evaluation, 2023), available at https://aspe.hhs.gov/sites/default/files/documents/1b652899fb99dd7e6e0edebbcc917cc8/aspe-part-d-oop.pdf.

Project 2025s drug pricing agenda calls for repealing the Inflation Reduction Act, primarily to end the law’s Medicare drug price negotiation provision, which would significantly lower the prices Medicare pays for select drugs and finally counter Big Pharmas unrestricted power to demand excessive Medicare drug prices. However, Project 2025 treats seniors’ access to affordable drugs as collateral damage. This dangerous agenda prioritizes Big Pharmas bottom line at the expense of millions of Medicare Part D enrollees who, if Project 2025 is enacted, may once again have to pay more out-of-pocket for the medications they need, impeding both access and affordability.

The positions of American Progress, and our policy experts, are independent, and the findings and conclusions presented are those of American Progress alone. A full list of supporters is available here. American Progress would like to acknowledge the many generous supporters who make our work possible.

Author

Nicole Rapfogel

Former Senior Policy Analyst, Health Policy

Team

Health Policy

The Health Policy team advances health coverage, health care access and affordability, public health and equity, social determinants of health, and quality and efficiency in health care payment and delivery.

Explore The Series

The far right’s new authoritarian playbook could usher in a sweeping array of dangerous policies.

Previous
Next

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.