The following excerpts are from the Medicare web site regarding upcoming changes that were signed into law in 2022.
Inflation Reduction Act:
CMS Implementation Timeline
- Starting January 1, people enrolled in a Medicare prescription drug plan will not pay more than $35 for a month’s supply of each insulin that they take and is covered by their Medicare prescription drug plan and dispensed at a pharmacy or through a mail-order pharmacy. Also, Part D deductibles won’t apply to the covered insulin product.
- Starting July 1, people with Traditional Medicare who take insulin through a traditional pump will not pay more than $35 for a month’s supply of insulin, and the deductible will not apply to the insulin. This will apply to people using pumps covered through the durable medical equipment benefit under Part B
- Starting January 1, adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles vaccine, will be available to people with Medicare Part D at no cost to them.
Medicare Part B drug rebates
- January 1 is the start of the first quarter for which drug manufacturers will be required to pay rebates to Medicare if prices for certain Part B drugs increase faster than the rate of inflation. The Part B inflation rebates for quarters in 2023 and 2024 must be invoiced by September 30, 2025.
Coinsurance for Part B drugs
- Starting April 1, people with Traditional Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increased faster than the rate of inflation in a benchmark quarter.
Medicare Part D drugs selected for the Drug Price Negotiation Program
- By September 1, CMS will announce the first 10 Medicare Part D drugs selected for the Drug Price Negotiation Program. Maximum fair prices negotiated for these first 10 Part D drugs will go into effect in 2026.
Coverage of ACIP-recommended vaccines
- Beginning October 1, most adults with coverage from Medicaid and CHIP will be guaranteed coverage of vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) at no cost to them.
Catastrophic phase of the Medicare prescription drug benefit
- Starting January 1, people with Medicare prescription drug coverage who fall into the catastrophic phase of the prescription drug benefit won’t have to pay any coinsurance or co-payments during that phase for covered Medicare prescription drugs.
Part D premium stabilization
- The law provides for a mechanism beginning January 1, 2024 for the average premium increase across most Part D plans to be limited to 6% over the previous year. This protection continues through 2029. The law also provides for a mechanism to stabilize plan premiums in 2030 and subsequent years.
Low-Income Subsidy Program
- Individuals with Medicare Part D who have low incomes will benefit from expanded financial help with prescription drug cost-sharing and premiums. The low-income subsidy program (LIS or “Extra Help”) under Medicare Part D will be fully available to certain people with Medicare with limited resources who earn less than 150% of the federal poverty level starting in 2024.
Cap on Part B payment for new biosimilars
- Starting July 1, there will be a cap on the Part B payment amount for new biosimilars when average sales price data is not available.
Drug Price Negotiation Program
- By September 1, CMS will publish the maximum fair prices negotiated for the first 10 Medicare Part D drugs selected for negotiation. Maximum fair prices for these first 10 drugs will go into effect in 2026.