Inflation Reduction Act’s Medicare Drug Price Program – RACmonitor
TL/DR –
The Centers for Medicare & Medicaid Services (CMS) has recently conducted patient-focused listening sessions as part of the Inflation Reduction Act’s Medicare Drug Price Negotiation Program. These sessions, which focused on the inaugural set of 10 selected drugs, provided a platform for patients and others to voice their experiences and concerns on access to these medications under the new framework. The key provisions of this law are designed to ensure broad access to these medications once negotiated prices come into effect in 2026, with all Medicare Part D plans required to cover each of the negotiated drugs in all available dosages and forms.
Medicare Drug Price Negotiation Program Listening Sessions: An Insight
The Centers for Medicare & Medicaid Services (CMS) recently publicized transcripts from patient-focused listening sessions, a key component of the Inflation Reduction Act’s Medicare Drug Price Negotiation Program. The program aims to make prescription drugs more affordable for Medicare Part D enrollees.
Conducted between Oct. 30 and Nov. 15, 2023, the sessions concentrated on the initial set of 10 drugs selected for negotiation. These drugs, including Farxiga, Fiasp/NovoLog, Januvia, Jardiance, Eliquis, Xarelto, Entresto, Stelara, Enbrel, and Imbruvica, were selected due to their clinical relevance and financial burden on patients. The sessions provided a platform for patients, caregivers, and patient organizations to discuss their experiences and concerns about accessing these medications under the new negotiation framework.
Despite public discourse focusing mainly on the negotiation process, potential drug development impacts, and legal challenges from pharmaceutical companies, the program’s effects on Medicare Part D enrollees’ access to these medications have not received as much attention.
Key provisions of the law, which come into effect in 2026, ensure broad access to these medications. All Medicare Part D plans must cover each of the negotiated drugs in all dosages and forms. CMS will regulate the placement of these drugs on formulary tiers, ensuring that decisions to place these drugs on non-preferred tiers, which involve higher patient cost-sharing, are justified.
CMS also aims to reduce the use of utilization management tools like prior authorization requirements, facilitating easier access to these medications for enrollees. Despite high coverage rates for most of these drugs across Part D plans, coverage variations exist, particularly for different dosages and forms. For instance, while nearly all enrollees have access to Xarelto tablets, coverage for its oral suspension drops to 78 percent.
As the program advances, these measures reflect a comprehensive approach to not only lowering drug prices but also ensuring enrollees have access to critical medications. This dual focus on affordability and accessibility underlines the program’s potential to significantly impact the lives of millions of Americans relying on Medicare Part D for their prescription drug coverage.
—
Read More US Economic News