Key Findings To Date
The Inflation Reduction Act (IRA)
- The out-of-pocket (OOP) average cost for the nine MFP medicines included in the analysis increased in total when comparing 1Q2025 to 1Q2024 and 2Q2025 to 2Q2024, but decreased in 3Q2025 compared to 3Q2024.
- The average OOP cost across all nine MFP drugs increased by $23 comparing 1Q2025 to 1Q2024 and $2.15 comparing 2Q2025 to 2Q2024. The average OOP cost across all nine MFP drugs decreased by $10.83 comparing 3Q2025 to 3Q2024.
- The average OOP cost for all nine MFP medicines increased by 31% comparing 1Q2025 to 1Q2024, increased 3.4% comparing 2Q2025 to 2Q2024, and decreased by 15% comparing 3Q2025 to 3Q2024.
- The average OOP cumulative cost Year-Over-Year has increased by 11% when comparing 1Q-3Q 2025 to 1Q-3Q 2024.
- Express Scripts, the second largest Pharmacy Benefit Manager (PBM), has increased OOP costs in all three quarters in 2025 compared to 2024. In addition, Express Scripts has the largest year-over-year increase in out-of-pocket costs for seniors.
- The OOP costs increased for five of the nine medicines with a negotiated MFP year-over-year to date.
- It is important to note that Stelara has biosimilar competition, with multiple biosimilars launched at the end of 1Q2025. Generic versions of Entresto are now available in pharmacies such as Mark Cuban Cost Plus Drug Company. In addition, Merck reduced the retail price of Januvia by more than 40% at the beginning of 2025. Such changes in market dynamics are expected to decrease OOP costs for patients.