Inflation Reduction Act Addendum

CMS is requiring a notice be provided to prospective and current members pertaining to cost-saving benefit changes as part of the Inflation Reduction Act (IRA) as of March 1, 2023.

The IRA requires drug companies that raise drug prices faster than the rate of inflation to pay Medicare a rebate. Medicare calls these, “Part B Rebatable Drugs”. Due to the IRA act, there are two changes occurring this year that can impact what a member pays for Part B medications.  

Change One

As of April 1, 2023, certain Part B rebatable drugs may be subject to a lower co-insurance. CMS will be providing plans with a list of medications eligible for the reduced co-insurance some time in the near future. The members’ cost share can vary by medication, and the eligible medications can change throughout the year. 

Change Two

Currently, insulin used in an insulin pump is subject to the durable medical cost share of 20% co-insurance.  Beginning July 1, 2023, under Medicare Part B, members who take insulin through a pump that is covered under Medicare’s durable medical equipment will pay no more than $35 for a one-month’s supply of covered insulin.