Under this provision, drug companies will be required to pay rebates to the Medicare program if prices rise faster than inflation. This applies to adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles and Tetanus-Diphtheria-Whooping Cough vaccines.īehind the scenes, other provision of the IRA become effective in 2023, including checks on the annual rise in costs of drugs. ![]() No Cost-sharing for Vaccines Covered under Part DĮffective January 1, 2023, cost-sharing for vaccines covered under Part D will be eliminated (even if an individual hasn’t met the Part D deductible). (See, e.g, this CMS National Training Program flyer “ Insulin Cost Sharing in 2023 Medicare Drug Plans”, Oct. As a second step, do another search with the individual’s insulin product and dosage to ensure it is covered by a given plan. As a work-around, CMS suggests first doing drug searches without insulin in an individual’s drug list, and add back in annual insulin costs ($35/mo x 12 = $420) to estimate maximum annual drug costs. Note re: Medicare Plan Finder and Insulin Copay Cap – because of when the IRA was passed relative to when Part D plans submitted their bid packages to the Medicare program for the 2023 plan year, the Medicare Plan Finder does not reflect the insulin copay caps, and will not do so throughout 2023 until 2024 plan information is posted. 2022), CMS has noted that it will be helping people who use insulin and who experience issues or concerns with their coverage, including choosing the wrong plan because they were unaware of the insulin cap, with a potential Special Enrollment Period (SEP) opportunity to change plans in 2023 (see, e.g., “ CMS Might Let Seniors Who Take Insulin Switch Plans Midyear” by Gabrielle Wanneh, Inside Health Policy (Oct. People who are charged more than $35 per month for their insulin in early 2023 may be reimbursed (see, e.g., this CMS memo re: Part B drugs (Nov. Note that Part D plans do not have to cover all insulin products at this copay level, only those insulin products that are on the plan’s formulary. Starting July 1, 2023, insulin furnished through durable medical equipment under Medicare Part B (such as insulin pumps) will be subject to the $35 per month cap (note that the Part B deductible will apply before then). Starting January 1, 2023, copayments for covered insulin products in Part D will be capped at $35 per month (with no deductible). ![]() Expands access to the Part D Low-Income Subsidy (“Extra Help”) (starting in 2024) – full LIS up to 150% of the Federal Poverty Level (FPL) with higher resource limits.įor more information, see this CMS Fact Sheet “ The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans” (Oct.Eliminates cost-sharing for adult vaccines covered under Part D (2023) and.Limits monthly out-of-pocket copays for insulin to $35 (starting in 2023).Imposes checks on the annual rise in costs of drugs and Part D premiums (limitations on drug prices start in 2023, and limitations on Part D premiums start in 2024).Caps beneficiary out-of-pocket Part D drugs costs at $2,000 per year (starting in 2025 – also allows spreading of costs over course of the year) in 2024, the 5% coinsurance for Part D catastrophic coverage will be eliminated).Allows Medicare to negotiate with drug manufacturers for the price of some Part D and Part B drugs (starting in 2026).Note that the Part D changes also generally apply to Medicare Advantage plans that provide Part D prescription drug coverage, known as Medicare Advantage Prescription Drug (MA-PD) plans. The following is a summary of the Medicare-related drug provisions in the IRA, to be phased in over the next several years. Overview of IRA Prescription Drug Provisions While some provisions will be phased in over the next few years, other provisions will become effective next month, in January 2023. This bill includes historic prescription drug provisions that will soon be of significant benefit to Medicare beneficiaries. 18, 2022), President Biden signed into law the Inflation Reduction Act (IRA) of 2022 on August 16, 2022. Listen to Medicare & Health Care StoriesĪs discussed in a recent CMA Alert (Aug.Join the Center for Medicare Advocacy Founder’s Circle.Career, Fellowship & Internship Opportunities.Ossen Medicare Outreach, Education and Advocacy Project. ![]()
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