Prescription Drug Coverage

Prescription drug coverage in the United States is provided through several government programs that help individuals afford necessary medications. These programs include Medicare Part D, which serves millions of seniors and people with disabilities, specialized initiatives to reduce drug prices, and military health benefits through TRICARE.

Medicare Part D Changes

In 2025, Medicare Part D introduced a $2,000 annual out-of-pocket cap on covered prescription drugs, protecting beneficiaries from high medication costs. The coverage gap, or “donut hole,” has been eliminated, simplifying the payment process. After a deductible (up to $590 in 2025), beneficiaries pay 25% coinsurance until reaching the out-of-pocket limit, then receive catastrophic coverage with no further cost-sharing for the rest of the year.

Drug Pricing Initiatives

Federal efforts to lower prescription drug prices include programs like TrumpRx, which negotiated deals to reduce costs on high-priced medications such as diabetes and weight-loss drugs for Medicare beneficiaries. These initiatives are part of a broader strategy to make medications more affordable nationwide (TrumpRx: How the Drug Pricing Program Works).

Military and TRICARE Coverage

Active duty military members, retirees, and their families receive prescription drug benefits through the TRICARE Pharmacy Program. This program offers access to medications via military pharmacies, retail networks, and home delivery, with varying cost-sharing options designed to provide affordable access for eligible beneficiaries (TRICARE Pharmacy Program: Using Military and Retail Pharmacies).