Which States Will See the Biggest Savings From Medicare Drug Negotiations? | Simplefill

The states that will likely see the biggest savings from Medicare drug negotiations are those with the largest Medicare populations, the highest use of expensive Part D and Part B drugs, and a high share of people with chronic conditions—states like Florida, Texas, California, New York, and Pennsylvania. For people in South Carolina, especially retirees in communities like Mount Pleasant, the savings may not be the very highest in the nation, but they will still be meaningful—especially for those who rely on negotiated drugs for chronic conditions.

How Does Medicare Drug Negotiation Work and Why Does It Vary by State?

Medicare’s new price negotiation authority, created under the Inflation Reduction Act, allows the Centers for Medicare & Medicaid Services (CMS) to negotiate prices for a limited list of high-spend drugs each year. CMS focuses on drugs with the highest total Medicare spending, long time on the market, and no generic or biosimilar competition, which means the impact is concentrated on medications that millions of people take for chronic, high-impact conditions.

Even though negotiated prices are set nationally, the savings look different state by state because of how many people in each state actually use those drugs. States with more Medicare enrollees, higher rates of diabetes, heart disease, arthritis, cancer, and autoimmune conditions, and greater reliance on expensive brand-name medications will see larger aggregate reductions in Medicare spending and out-of-pocket costs.

Which States Are Positioned for the Largest Total Medicare Savings?

When you look at overall Medicare spending, certain states stand out because of their size and demographic mix. States most likely to see the biggest total dollar savings from negotiated drug prices include:

• Florida, with its large retiree population and heavy use of Part D plans for chronic conditions like heart failure, diabetes, and COPD.
• California, which combines a huge population with significant numbers of Medicare Advantage and Part D enrollees using high-cost specialty drugs.
• Texas and New York, both of which have high Medicare enrollment and substantial spending on brand-name cardiovascular, oncology, and autoimmune drugs.
• Pennsylvania and Ohio, where older populations drive high utilization of the drugs most likely to be selected for negotiation.

From a patient’s perspective, that doesn’t mean people in other states are left out; it simply means the largest total savings will cluster where Medicare spending is already highest.

Why Might Some States Benefit More Than Others?

Because negotiated prices apply nationwide, the “which states benefit most” conversation is really about where the drugs on the negotiation list are used most heavily. States with these characteristics will tend to see larger total savings:

• Large Medicare enrollment and high per-capita Medicare spending on Part D and Part B drugs.
• High rates of chronic conditions treated by negotiated drugs, such as diabetes, heart failure, cancer, rheumatoid arthritis, and autoimmune disease.
• Heavy use of single-source, brand-name medications with no generics or biosimilars, which are exactly the drugs CMS targets.​

On the other hand, a state with fewer older adults, greater reliance on generics, or lower uptake of the negotiated drugs will see smaller aggregate savings—even though individual patients may still benefit.

What Do Medicare Drug Negotiations Mean for Patients?

Many patients are in a similar situation: they have Medicare, but they still struggle with high out-of-pocket costs for necessary medications. Negotiated prices help in several ways:

• Lowering what plans pay for certain high-cost drugs, which can translate into lower copays and coinsurance for people in Medicare Part D.
• Reducing the risk that patients hit the coverage gap or face unaffordable coinsurance late in the year, especially before the new Medicare prescription drug cap is fully in effect.
• Making it easier for people with fixed incomes—especially retirees along the South Carolina coast—to stay on the medications their doctors prescribe instead of skipping doses.

For those whose medications are not yet included in negotiations, working with a patient assistance program can unlock additional savings through manufacturer programs, grants, and other sources.

How Can Patients Maximize Savings Beyond Medicare Negotiations?

Even in the states with the largest projected savings, negotiated prices alone rarely solve every affordability problem, especially for people taking multiple brand-name medications. That’s where a full-service prescription assistance partner becomes essential.

An organization like Simplefill helps patients:

• Identify whether their drugs are affected by Medicare’s negotiation program or other provisions like the new annual drug cap.
• Enroll in a patient assistance program for brand-name medications, especially when they have high out-of-pocket costs or fall into the “donut hole.”
• Use a medication assistance program to connect with nonprofit foundations, manufacturer-sponsored programs, and other resources to reduce monthly costs.

When Should Someone Ask for Help With Medication Costs?

In practice, the best time to seek help is as soon as your prescription costs start to strain your budget, rather than waiting until you are deep into the year or already in a coverage gap.

Warning signs include:

• Monthly prescription costs regularly over 100–200 dollars, even with Medicare coverage.
• Skipping refills or cutting pills in half to try to make your medication last longer.
• Being denied for a manufacturer copay card or feeling overwhelmed by the paperwork for assistance programs.

A full-service prescription assistance company can review your situation, identify programs and potential savings, and handle the applications and renewals for you so you can focus on your health.

Get Affordable Access to Prescription Medications

Simplefill is a full-service prescription assistance company that researches, qualifies, and maintains patients’ enrollment in all sources of assistance available to them.

Apply today by calling 877-386-0206. A caring Simplefill representative will contact you within 24 hours to discuss your application and, if qualified, enroll you in the program.

FAQs About Medicare Drug Negotiations and Savings

How does the Medicare drug price negotiation program work?

The Medicare Drug Price Negotiation Program lets Medicare negotiate prices directly with drug manufacturers for a limited list of high-spend Part D and Part B drugs, based on factors like total Medicare spending, years on the market, and lack of generic or biosimilar competition. Negotiated prices are then implemented nationally for eligible beneficiaries, with new groups of drugs added over time.

When will patients across the US start to see savings?

The first negotiated prices apply to an initial group of drugs and begin phasing in over the middle of this decade, with additional drugs and price changes scheduled in subsequent years. For many people with Medicare Part D, the most noticeable savings will come as negotiated prices combine with the new annual prescription drug cap to limit overall out-of-pocket spending.

Will every Medicare drug be negotiated or get cheaper?

No, only a select list of high-impact drugs is eligible for negotiation, and certain medicines—such as orphan drugs for very rare conditions, plasma-derived products, generics, and biosimilars—are excluded from the program. Many other prescriptions will continue to be priced through normal plan negotiations, formulary decisions, and existing manufacturer discount or prescription assistance programs.

What can I do if my medication isn’t on the negotiated list?

If your drug is not yet negotiated, you may still benefit from the new Medicare prescription drug cap, plan-level discounts, or manufacturer and nonprofit patient assistance programs that reduce out-of-pocket costs. A full-service medication assistance program can help you compare options, check your plan’s formulary, and enroll in available programs so you can keep affording your medications over the long term.