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Feb 9, 2024
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How the Inflation Reduction Act prescription drug provisions impact Medicare beneficiaries  

Blue KC is keeping a pulse on the developments of the Inflation Reduction Act of 2022 and impacts to our members and 2025 Blue Medicare Advantage plan design. The Inflation Reduction Act includes provisions to lower prescription drug costs for beneficiaries with Medicare and reduce drug spending by the federal government.   

Prescription drug provisions include:  

  • Limit monthly cost sharing for insulin to $35 for people with Medicare (began in 2023)  
  • Require drug companies to pay rebates to Medicare if prices rise faster than inflation for drugs used by Medicare beneficiaries (began in 2023)  
  • Eliminate cost sharing for adult vaccines covered under Part D and improve access to adult vaccines in Medicaid (began in 2023)  
  • Expand eligibility under the Part D Low-Income-Subsidy (LIS) Program to full benefits for individuals with incomes between 135% and 150% federal poverty level (beginning 2024)  
  • Cap out-of-pocket (OOP) spending for Part D enrollees and make other Part D benefit design changes (beginning in 2024):  
    • Eliminate 5% coinsurance for catastrophic coverage in Part D in 2024  
    • Cap OOP drug spending at $2,000 beginning in 2025  
    • Allow spreading OOP costs over the year in 2025  
    • Limit annual increases to no more than 6% per year in Part D premiums for 2024-2030  
  • Require the federal government to negotiate prices for some top-selling drugs covered under Medicare Part B and Part D (beginning in 2026 through 2029)  
  • Delay implementation of Trump administration’s rebate rule to 2032.  

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