ENROLLED IN MEDICARE and want to avoid shingles? Good news: As of Jan. 1, the Shingrix vaccine is free for enrollees with a Part D prescription drug plan. Before this year, that two-dose vaccine could run over $200 per dose. 

Enrolled in Medicare and need insulin for your diabetes? More good news: Also as of Jan. 1, your copay for a 30-day supply of insulin covered by your Medicare Part D plan is now capped at $35. During the pandemic, when insulin shortages emerged, a month’s supply could cost hundreds of dollars.

These benefits are the first to reach consumers as a result of landmark legislation signed into law in August that aims to reduce pharmaceutical costs. While they might seem modest in scope and affect only people on Medicare, broader reforms taking effect over the next few years promise significant savings for far more Americans, a victory which AARP long fought for.

But because the drug-price changes were part of a much larger legislative package, public awareness of them is low. Here are answers about what changes are planned, as well as what else likely will be in motion in 2023 in the quest to lower medicine costs.

Yes. Starting in 2023, drugmakers who raise prices more than the general inflation rate will have to pay Medicare a rebate for the amount above the inflation rate. Another main feature of the new law allows Medicare to negotiate prices for a limited number of highly prescribed drugs on behalf of the entire program. The first step will happen this year as the U.S. Department of Health and Human Services determines which drugs will be negotiated, based on a set of criteria included in the law; while there’s been no word on the specifics so far, the ultimate goal is to focus over time on the 100 drugs that Medicare spends the most dollars on each year. New prices resulting from the negotiations will take effect in 2026.

Until now, negotiating for the best drug prices was left to individual Medicare Part D plans. By negotiating on behalf of tens of millions of beneficiaries, Medicare officials believe they can achieve billions in savings. Those dollars could then be applied to lower everyone’s premiums, fund other benefits, shore up the program’s long-term health or make other program improvements.

There are a few that are certain to have a big impact on older Americans.

In 2024, once a Medicare Part D enrollee reaches the “catastrophic coverage” spending threshold, they will no longer have to pay any out-of-pocket costs. (Experts project that threshold to be $7,750 by 2024.) Previously, they would have to pay 5 percent of their drug costs above the threshold, with no limit.

That is a stepping stone to the bigger reform that starts in 2025: a $2,000-a-year cap on out-of-pocket prescription drug spending for all Part D Medicare enrollees. Currently, there are no limits on how much Part D enrollees have to pay out of pocket.

Maybe. The new law continues to help those who purchase health insurance on the individual market by extending until the end of 2025 the Affordable Care Act premium subsidies that were instituted under the American Rescue Plan Act of 2021. This means no one will have to pay more than 8.5 percent of their annual income for an ACA insurance plan.

President Joe Biden has said he plans to again ask Congress to put the $35 insulin out-of-pocket cap on all insurance plans, not just Medicare. Beyond that, there isn’t any other significant drug-related legislation on the docket.

Six states—Colorado, Florida, Maine, New Hampshire, New Mexico and Vermont—have passed laws that would allow residents to order drugs from another country, mainly Canada. Five of them have applied to the federal government for approval to start their programs, but all are waiting for a decision by the U.S. Food and Drug Administration. This agency needs to be sure that the imported drugs meet U.S. standards. There is no word yet on when the FDA will rule on those applications.

Over the past five years, more than 240 measures have been passed across all 50 states that relate to the high cost of medications. The laws involve drug importation, the creation of drug affordability boards that monitor and act on drug price increases, and capping out-of-pocket costs of some drugs (most notably insulin).