CMS announces 27 Part B drugs for which coinsurances may be lower starting April 1
Drug companies will pay rebates or face fines for raising prices faster than inflation.
Photo: Jose Luis Pelaez/Getty Images
The Centers for Medicare and Medicaid Services has announced 27 prescription drugs for which Part B beneficiary coinsurances may be lower starting April 1 through June 30.
Lower Part B coinsurance will go into effect on April 1 and will be reviewed quarterly. This coinsurance adjustment applies to certain drugs and biologicals covered under Medicare Part B and may change quarterly.
CMS released information about the 27 Part B drugs and biological products in the quarterly ASP (Average Selling Price) public file.
One of the drugs is Humira, the AbbVie offering that treats arthritis. The others are listed here.
WHY THIS MATTERS
Some people with Medicare who take these drugs may save between $2 and $390 per average dose, depending on their individual coverage, CMS said.
CMS announced the drug-pricing initiative earlier this year and said that drug companies that raise prices faster than the inflation rate will pay rebates to the federal government or face fines.
By reducing coinsurance for some people with Part B coverage and discouraging drug companies from increasing prices faster than inflation, Medicare Prescription Drug Inflation Rebate Program may lower out-of-pocket costs for some people with Medicare and reduce Medicare program spending for costly drugs, CMS said.
THE LARGER TREND
The Inflation Reduction Act, which passed last year, has several initiatives for lowering drug prices in Medicare. Under the law, drug companies that raise prices higher than inflation will pay rebates or face fines.
Medicare can negotiate drug prices for the first time for 10 high-cost drugs that have yet to be determined, starting in 2026. Starting in 2025, Medicare beneficiaries get a $2,000 annual cap on out-of-pocket drug expenses. Those who have Medicare for insurance get a $35 monthly cap on insulin.
ON THE RECORD
"The Biden-Harris Administration believes people with Medicare shouldn't be on the hook when drug companies inexplicably jack up the prices of their drugs," said HHS Secretary Xavier Becerra. "President Biden made lowering prescription drug costs for Americans a top priority and we're using every lever we have to deliver results. With the inflation rebate program, we are fighting to ensure seniors can afford the treatments they need, taxpayers aren't subsidizing drug company excess prices, and the Medicare program is strong for millions of beneficiaries now and in the future."
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
Salim Ismail will offer more detail at his HIMSS23 presentation "Executive Summit Keynote: Disruptive Convergence." It is scheduled for Monday, April 17, at 3:45 - 4:30 p.m. CT at the Marriott Marquis Chicago, Level 4, in the Grand Horizon Ballroom.
