Medicare enrollees to pay less for 64 additional drugs
The drugs will have a lowered Part B coinsurance rate from January 1 through March 31 of next year, HHS says.
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Some Medicare enrollees will pay less for 64 drugs available through Medicare Part B, according to the Department of Health and Human Services.
The drugs will have a lowered Part B coinsurance rate from January 1 through March 31 of next year; that's because drug companies raised prices for each of the 64 drugs faster than the rate of inflation, said HHS.
More than 853,000 people with Medicare use these drugs annually to treat conditions such as cancer, osteoporosis and substance use disorder, the agency said. The drugs join a list of more than 120 others, which HHS has linked to the Inflation Reduction Act's Medicare Prescription Drug Inflation Rebate Program.
WHAT'S THE IMPACT?
Due to the IRA, some people with Medicare who use these drugs in the first quarter of 2025 may save between $1 and $10,818 per day, according to HHS estimates. For example, Atgam treats a rare blood condition known as aplastic anemia. A beneficiary taking Atgam may save as much as $12,728 from January through March, depending on their coverage and course of treatment.
Another cost-savings benefit begins January 1, when all people with Medicare Part D will benefit from a $2,000 cap on annual out-of-pocket prescription drug costs in 2025. HHS predicts that this provision will lead to bigger individual savings, with Part D enrollees expected to save billions in out-of-pocket costs.
Also starting January 1, people with Medicare Part D can choose to spread out their out-of-pocket prescription drug costs throughout the calendar year, rather than paying all at once at the pharmacy.
The Inflation Reduction Act also requires drug companies to pay rebates to Medicare when prices increase faster than the rate of inflation for certain drugs. The Centers for Medicare and Medicaid Services intends to begin invoicing prescription drug companies for Part B inflation rebates owed to Medicare no later than September 30, 2025, and Part D inflation rebates no later than December 31, 2025.
The rebate amounts paid by drug companies will be deposited in the Federal Supplementary Medical Insurance Trust Fund, which HHS said will help ensure the long-term sustainability of the Medicare program.
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. HHS 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.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
