Biden’s drug price reform rollout: What to expect in 2023 and 2024

As part of President Joe Biden’s Inflation Reduction Act, which aims to help reduce the cost of health care and prescription drugs in particular, people with traditional Medicare who take insulin will not pay more than $35 for a month’s supply beginning July 1.

Biden signed the wide-ranging Inflation Reduction Act last summer in part to help reduce the cost of health care in general and prescription drugs in particular. So far, so good, said Clare Pierce-Wrobel of the White House Domestic Policy Council.

“For decades, we know Americans have gotten squeezed by rising health care costs, and they are paying two to three times more for prescription drugs than people in other developed countries,” she said. “But with the Inflation Reduction Act, President Biden is delivering lower health care costs and prescription drug costs for American families. It really is one of the most consequential health care laws since the Affordable Care Act.”

Pierce-Wrobel and other government officials discussed implementation of the IRA’s prescription drug reforms during a May 18 webinar. Key pieces of the law already have gone into effect and people are feeling the benefits, said Meena Seshamani, Ph.D., deputy administrator and director of the Center for Medicare.

“As of January 1, millions of people with Medicare Part D now have their insulin costs capped at $35 a month for each covered insulin they take,” she said. “Those with Medicare Part B will see these same benefits, beginning in July.”

Stacy Sanders, counsel to the secretary of Health and Human Services, summarized several of the law’s key provisions:

• Expanded coverage. “A record 16 million Americans signed up for Marketplace coverage,” she said. “Four out of five customers of the Marketplace plan in 2022 had access to a plan for $10 or less after subsidies. Customers in these plans saved an average of $800 on their premiums in 2021, and this help will be extended through 2025.”
• Insulin costs. “We know that 1.5 million people enrolled in Medicare Part D would have saved $734 million if these insulin provisions had been in effect in 2020, saving senior citizens and people with disabilities an average of $500 per person,” Sanders said.
• Vaccination costs. “Eventually, the law makes available free vaccines through Medicare Part D,” she said. “Certain recommended preventive vaccines such as shingles are now available to seniors and people with disabilities who have Medicare free of charge.
• Out-of-pocket costs. “Starting in 2024, people enrolled in Medicare prescription drug coverage who take very high-cost drugs, such as those for multiple sclerosis or cancer, no longer will have to pay after they reach the catastrophic phase,” she said. “Building on that in 2025, people with Medicare Part D won’t pay more than $2,000 out of pocket per prescription drug a year.”
• Price negotiation. “The law finally gave Medicare the tools it needs to lower prescription drug prices by allowing Medicare to negotiate the price of prescription drugs,” Sanders said.
• Inflation rebates. “The new law requires drug companies that raise their drug prices faster than the rate of inflation to pay Medicare a rebate,” she said. “This will lead to a stronger Medicare for current and future enrollees and discourage unreasonable price increases by drug companies.”

Several key milestones in the implementation of the prescription drug provisions of the IRA are scheduled through the remainder of this year:

• 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.
• By September 1, the Centers for Medicare & Medicaid Services 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.
• 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 at no cost to them.

Related: New Medicare Drug Negotiation Program: Initial guidance from CMS

“The law will improve the overall financial health of the Medicare program, ensuring it is strong for the millions of people it serves, both now and in the future,” Seshamani said.

Additional information about the IRA and prescription drugs is available at www.cms.gov/inflation-reduction-act-and-medicare.