Pharmaceutical Commerce: A Look at the Medicare ‘Extra Help’ Program

As a result of the Inflation Reduction Act, 2024 brings much needed change to the Medicare Part D benefit—helping to lower out-of-pocket costs for prescription medications for many.

Two changes went into effect on January 1, 2024, the elimination of the five percent cost-sharing in the catastrophic phase and the expansion of the Extra Help program. Eliminating the five percent cost-sharing obligation means, for the first time, people with Medicare Part D plans will no longer have unlimited financial liability for their out-of-pocket prescription costs through the catastrophic phase. Instead, they now have a cap of about $3,250 in out-of-pocket costs for their drugs, which is especially beneficial for those who need access to expensive treatments.

The expansion of the Extra Help program could have a huge impact for patients with lower incomes. Many patients who struggle to afford the healthcare costs related to their prescription drugs will benefit, but not enough patients know about the program or how it works.

In this article for Pharmaceutical Commerce, PAN Foundation Chief Advocacy and Engagement Officer Amy Niles, explains the Extra Help program, who is eligible, how it has changed, and the impact these changes will have on patients.