The federal government has sent a record $16 billion to health insurers that sell Medicare drug plans, a flashing red sign that prescription drug spending is blowing up far beyond what government officials and insurance experts had expected.

The good news for Medicare patients: They are shielded from higher drug costs because the Inflation Reduction Act has limited their out-of-pocket spending. Concerns arise, however, for the broader public: Pharmaceutical companies get bigger sales as more people fill their medications, and insurers remain protected from sizable losses — while taxpayers are left holding the bag.

Every year, Medicare looks at drug spending data and calculates whether the insurers’ drug plans, known as Part D plans, spent more or less than what they had projected at th

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