For Medicare beneficiaries (populations aged 65 and older and some people who have a disability) prescription drug coverage is available under the Part D benefit. However, structural shortfalls within the Medicare Part D market threaten to exclude the most vulnerable Americans, specifically those residing in rural areas and those with complex health needs.
There are two primary forms of prescription drug coverage through Medicare. The first is through standalone Part D prescription-drug plans (PDPs), which are offered by private insurance companies and available as an add-on to beneficiaries enrolled in Traditional Medicare (Fee-For-Service Medicare benefit under Parts A and B). The second is Medicare Advantage prescription drug plans (MA-PDs), which bundles coverage with medical coverage offered through private plans, known as Medicare Advantage (Medicare Part C).
The market for stand-alone Part D drug plans is now shrinking, with about 25 million enrollees. Private insurance companies make more money from Medicare Advantage plans than from standalone drug plans, so many companies steer people who start out in a standalone Part D plan toward Medicare Advantage instead. As enrollment shifts to MA, the number of standalone plans and private insurers offering these plans has shrunk significantly.
This puts vulnerable communities at risk. People in rural areas may not have access to comparable Medicare Advantage plans and individuals with complex health needs often rely on Traditional Medicare. For these two groups, PDPs are essential. As the number of PDPs available declines, these groups are left with fewer options that meet their needs and ensure access to life-saving medications.
In May of 2026, Camber led research and developed a set of potential policy solutions to rectify the market failures in the Medicare Part D market. Camber conducted a literature review, convened and interviewed subject matter experts, and developed policy options based on the research.
Over a 3-month period of research and in-depth conversations, Camber designed potential reforms and investigated their feasibility, durability, and potential impact. This resulted in the development of three policy options for stabilizing the Medicare Part D market:
The work was published publicly, including in Health Affairs and in a White Paper. The work is intended to shape the broader national conversation around the problems of the declining Medicare Part D market and possible policy solutions that could be considered by policymakers to address the issue, including current administrative authority that CMS could leverage immediately to provide access to a Part D stand-alone option.
This engagement demonstrates Camber’s thought leadership and field-building capacity in developing tangible policy options that can protect the health and wellbeing of millions of Americans.
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