HHS announces 54 drugs subject to rebates and lower coinsurance 

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The Centers for Medicare and Medicaid Services has released the names of 54 drugs whose prices have risen faster than the rate of inflation.

Drug companies will be required to pay rebates to Medicare under the Inflation Reduction Act. CMS said it intends to begin invoicing prescription drug companies for rebates no later than the fall of 2025. 

The rebate amounts paid by drug companies will be deposited in the Federal Supplementary Medical Insurance Trust Fund. 

Medicare and Medicare Advantage beneficiaries who use these drugs are expected to have a reduced coinsurance amount.

From October 1 through December 31, 54 Part B drugs have an adjusted coinsurance rate based on the inflation-adjusted payment amount. The coinsurance will be 20% of the inflation-adjusted payment amount, CMS said.

For example, someone taking the drug called Kymriah, which treats cancer, could save as much as $3,000. 

For a full list of the drugs subject to inflation-adjusted coinsurance, see the CMS list.

WHY THIS MATTERS

Over 822,000 people with Medicare use these drugs annually to treat conditions such as cancer, osteoporosis and pneumonia. 

The drugs will have a lowered Part B coinsurance rate from October 1 through December 31. People with Medicare who use these drugs during the last quarter may save between $1 and $3,854 per day, according to CMS. 

THE LARGER TREND

Since April 1, 2023, people with Medicare have saved money for over 100 drugs due to the Inflation Reduction Act's Medicare Prescription Drug Inflation Rebate Program. Medicare enrollees pay less out-of-pocket for these drugs because their prices have increased faster than the rate of inflation.

Since January 2023, the inflation rebate applies to certain Medicare Part B drugs. The Department of Health and Human Services said it intends to invoice drug manufacturers for 2023 and 2024 Part B inflation rebates no later than the fall of 2025. 

The Medicare Prescription Drug Inflation Rebate Program also allows the federal government to negotiate drug prices with manufacturers. In August, agreements for lower prices were reached for 10 drugs selected under the first round of the program. CMS estimates that had these prices been in effect last year, Medicare would have saved an estimated $6 billion. 

Once these prices take effect in 2026, people with Medicare Part D are expected to save an estimated $1.5 billion in total out-of-pocket costs, CMS said.  

Also in 2025, Medicare Part D beneficiaries will get a $2,000 cap on annual out-of-pocket prescription drug costs. This year, some enrollees are already seeing their annual out-of-pocket costs capped at about $3,500, CMS said. 

ON THE RECORD

"The Biden-Harris Administration is dedicated to ensuring people with Medicare have access to their prescription drugs, and the Inflation Reduction Act continues to deliver on our goal to improve affordability," said CMS Administrator Chiquita Brooks-LaSure. "Discouraging price increases above the rate of inflation by drug companies and negotiating lower prices on some of the most expensive and most frequently used drugs in the Medicare program delivers on our promise to bring savings to Medicare enrollees."  

Email the writer: SMorse@himss.org