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It’s that time of year again, where PDP enrollment goes wild and we all kick it into high gear. This AEP is unlike any other as we have a ton of changes happening with Part D plans – let's dive into it.
Please Check Client Formularies
Before we get into all the Part D updates and some carrier highlights, I have to make sure every agent reads this: check everyone's formulary.
I had a client complain about the cost of Januvia in 2024. It cost her $400-$500 over the course of the year. In 2025, the same product she has now changed the formulary and doesn't cover Januvia anymore.
If we hadn't seen that and moved her to something else, her cost would have been tens of thousands of dollars in the event there is no other alternative.
Please be diligent. Your clients need your help this fall perhaps more than ever before.
Fewer Part D Plans in 2025
The number of Medicare Part D plans is dropping in 2025, and it’s something your clients should be prepared for.
Beneficiaries will have access to 524 stand-alone Prescription Drug Plans (PDPs), which is a 26% reduction compared to 2024. Even with fewer plans, there’s still a choice of at least 12 PDPs in every state.
This reduction is even more noticeable for beneficiaries eligible for the Low-Income Subsidy (LIS). The number of premium-free "benchmark" plans available to LIS recipients has fallen by 9%, leaving just 115 options nationwide. Depending on where your clients live, they might see anywhere from two to six benchmark plans available.
Despite the decline in stand-alone PDP options, the availability of Medicare Advantage plans that include drug coverage (MA-PDs) continues to grow.
In 2025, beneficiaries will have access to more MA-PD plans in most areas, providing them with a wider range of choices, often at lower or zero premiums compared to PDPs. This trend is worth noting, as more clients may shift toward MA-PDs to take advantage of bundled coverage options.
Premiums Are Going Up
In 2025, the base beneficiary premium for Part D will rise by 6%, landing at $36.78.
While the Inflation Reduction Act caps the premium increase, your clients may still experience fluctuations depending on their specific plan. It’s important to review options and help clients find the plan that offers the best value for their needs, especially if they see a significant jump in their monthly costs.
Expanded Low-Income Subsidy Benefits
There’s good news for your clients who qualify for the Low-Income Subsidy (LIS) program.
As of 2024, all beneficiaries who meet the eligibility criteria now receive full benefits. Previously, those with incomes between 135% and 150% of the federal poverty level only received partial assistance.
Be sure to check if any of your clients qualify for these expanded benefits, as it could dramatically lower their prescription drug costs.
You can learn more about all these changes in our 2025 Playbook.
Clients Could Struggle to Find Drugs
Medicare's new negotiated prices for certain medications are set to benefit a lot of people, but there's a catch—many independent pharmacies might not carry them.
In fact, a recent survey shows that 51% of independent pharmacy owners are seriously considering skipping the first 10 drugs on the negotiation list. Why? The upfront cost to stock these medications is steep, with an average pharmacy expected to absorb $27,000 per month before they see any manufacturer rebates.
This means your clients could face challenges in actually getting their hands on these lower-cost drugs, especially if they rely on smaller, local pharmacies. With 40% of pharmacies still undecided, access might vary widely depending on location.
Drugs like Eliquis, Jardiance, and Januvia may not be on the shelf in some areas, potentially putting a strain on seniors who rely on them for essential treatments. It's definitely something worth keeping an eye on as these changes roll out.
Most Competitive 2025 Part D Carriers
As always, everything is based on your location, but the stars of the show for 2025 are still going to be Wellcare and Cigna.
When we spot check multiple locations, we consistently see Wellcare and Cigna at the top of the list with the most competitive plans.
Wellcare's $0 Premium PDP
For 2025, the showstopper prescription drug plan is once again Wellcare’s Value Script. As a reminder, Wellcare does not pay commission on Part D plans, for the record.
This year, the Value Script plan holds its ground as one of the lowest-cost PDPs on the market, with premiums below benchmark in 49 states and a $0 premium available in 43 states, thanks to Wellcare’s participation in the Part D Premium Stabilization Demonstration.
More than 1.4 million current members will see reduced cost-sharing this year due to improvements in the formulary. All of Wellcare’s plans include a $0 copay on Tier 1 prescriptions at preferred pharmacies, with Walgreens, CVS, and select grocers rounding out an extensive preferred pharmacy network with over 60,000 locations.
Wellcare has also invested $22 million in resources for members, including an enhanced Find a Provider tool and onboarding videos in eight languages.
Past practices offer a glimpse into future performances, so just keep in mind the history of Wellcare's support when guiding your client decisions.
Cigna
Another PDP carrier that caught our attention for 2025 is Cigna.
For the 2025 Medicare Annual Enrollment Period, Cigna Healthcare offers a stable lineup of Prescription Drug Plans (PDPs) with competitive benefits and pricing.
- Cigna Healthcare Saver Rx: Ideal for budget-conscious clients, the Saver Rx plan offers low premiums and low to $0 copays on many generic drugs. Select supplemental benefits include prescription vitamins, making this plan a versatile, cost-effective choice for individuals focused on managing their healthcare expenses without sacrificing coverage.
- Cigna Healthcare Assurance Rx: This plan is structured to benefit clients receiving Extra Help or those seeking reliable, foundational coverage. Assurance Rx provides essential benefits with affordable rates, ensuring that clients with basic coverage needs can maintain manageable costs.
- Cigna Healthcare Extra Rx: For clients seeking extensive coverage, the Extra Rx plan delivers flexibility and a comprehensive drug list, featuring savings on many generics, a low deductible, and gap coverage. This plan also includes supplemental benefits such as prescription vitamins and offers low-cost options for clients who prefer to use Cigna’s extensive pharmacy network.
All of Cigna’s PDPs include $0 copay options for select medications when ordered through preferred home delivery.
MedicareCENTER Updates
If you haven't registered for MedicareCENTER yet, do that now!
You can quote and enroll your clients right in MedicareCENTER.
There are also some big updates for this AEP, which make it easier for you to find, connect with and serve your clients!
- Contact Map: Contact Map, now available in the Integrity for Agents mobile app, allows you to find, filter and sort your clients by location. Search results show up on a zoomable map so you can connect with clients more efficiently.
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Low Income Subsidy (LIS): Now, you have the option to indicate if your client is eligible for LIS assistance right in your Contact Profile. Plan options are then automatically filtered accordingly to reflect the LIS status. In addition, PlanEnroll lets consumers indicate their LIS eligibility on their Profile, so their plan card reflects changes based on their eligibility. Your clients can also indicate this status in the coverage section of Client Sync — allowing you to get that information along with their Medicaid status.
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Multi-pharmacy: You can now enter up to three pharmacies at once and compare prices for your clients! Consumers will also be able to select up to three pharmacies to compare pricing when they use their agent's Personal Agent Website link. They can then set a preferred pharmacy and save it to their PlanEnroll Profile — updating the agent when they make changes.
Conclusion
For 2025, Wellcare and Cigna are going to be the most competitive Part D choices for many of your clients.
Make sure you get contracted and register for a MedicareCENTER account if you haven't already.
New to Part D sales? Check out our comprehensive sales guide, How to Sell Medicare Part D.
