Patients Face New Barriers for GLP-1 Drugs Like Wegovy and Ozempic
Even With Lower Prices, Medicare, Medicaid, and Other Insurers Tighten Coverage for Drugs Like Mounjaro and Zepbound Using Prior Authorization and Other Tools
In Their Own Words
Medicare’s Hidden Fix for High Drug Costs
Medicare’s Payment Plan Can Ease Seniors’ Crushing Drug Costs but Medicare Buries it in the Fine Print
Print:
The op-ed was published by the Philadelphia Inquirer on February 3, 2026.
Imagine you are a 70-year old patient sitting in your oncologist’s office, processing a life-altering diagnosis. Your doctor prescribes a pill for your cancer that offers the best chance of survival. You arrive at the pharmacy, expecting a co-pay, but the bill looks more like a mortgage payment. “That will be $2,000 for the prescription,” the pharmacist says.
Now, imagine Medicare offers a payment plan to soften the blow. There’s just one catch: You need to know the program exists so you can sign up for it — which itself can be tricky. The Medicare Prescription Payment Plan (MPPP) may be the program’s best-kept secret, one that could help you or someone you love afford life-saving drugs. But most Medicare patients don’t know about it.
For millions of seniors, high costs for prescription drugs aren’t a hypothetical nightmare; they are a structural failure built into the Medicare Part D drug program. For years, the rules on coverage for the costliest drugs — for conditions like cancer, rheumatoid arthritis, and multiple sclerosis — have been an open scandal. Just a few years ago, many cancer patients had to pay $20,000 out-of-pocket annually for their medicines.
The Inflation Reduction Act (IRA) was designed to fix this. The law capped annual out-of-pocket drug costs at $2,000 in 2025 for all Medicare patients. This translates to an astounding 90% discount for many cancer patients. This annual maximum will slowly rise in future years.
Read the full op-ed.
Authors
Jalpa Doshi, PhD
Director, Value Based Insurance Design Initiatives, Center for Health Incentives and Behavioral Economics and Leon Hess Professor, Internal Medicine, Perelman School of Medicine
John Lin, MD, MSHP
Assistant Professor, Department of Health Services Research, University of Texas MD Anderson Cancer Center
More on Health Care Access and Coverage
How One Study Helped Save Free Preventive Care in a Supreme Court Showdown
A 2024 Study Showing How Even Small Copays Reduce PrEP Use Fueled Media, Legal, and Advocacy Efforts As Courts Weighed a Case Threatening No-Cost Preventive Care for Millions
Insurers’ Utilization Management Tools Vary Widely on Anti-Nausea Drugs for Cancer
Chart of the Day: LDI Researchers Report Major Coverage Differences Across ACA and Medicaid Plans, Affecting Access to Drugs That Treat Chemo-Related Nausea
Why You May Have Fewer Health Insurance Choices Than Your Neighbor
Insurers Avoid Counties With Small Populations and Poor Health but a New LDI Study Finds Limited Evidence of Anticompetitive Behavior
Acupuncture Could Fix America’s Chronic Pain Crisis–So Why Can’t Patients Get It?
A Proven, Low-Risk Treatment Is Backed by Major Studies and Patient Demand, Yet Medicare and Insurers Still Make It Hard To Use
Integrated Care Plans Didn’t Boost Medicaid Enrollment for the Poorest Seniors
Chart of the Day: Medicare-Medicaid Plans—Created to Streamline Care for Dually Eligible Individuals—Failed to Increase Medicaid Participation in High-Poverty Communities