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In general, Part D spending depends on several factors, including the total number of Part D enrollees, their health status and the quantity and type of drugs used, the number of high-cost enrollees (those with drug spending above the catastrophic threshold), the number of enrollees receiving the Low-Income Subsidy, the price of drugs covered by Part D and the ability of plan sponsors to negotiate discounts (rebates) with drug companies and preferred pricing arrangements with pharmacies, and to manage use (e.g., promoting use of generic drugs, prior authorization, step therapy, quantity limits, and mail order)

For example, the half-life of diazepam increases with patient age