CMS Announces 27 Part B Drugs That May Reduce Co-Insurance Effective April 1

The Centers for Medicare and Medicaid Services has announced 27 prescription drugs for which Part B coinsurance may be lower from April 1 to June 30.

Lower B Coinsurance will take effect April 1 and be reviewed quarterly. This co-insurance adjustment applies to certain Medicare Part B drugs and biologics and may change quarterly.

CMS has published information on 27 Part B drugs and biologics in a public quarterly ASP (Average Selling Price) file.

WHY IS IT IMPORTANT

Some people with Medicare who take these medications can save between $2 and $390 per average dose, according to CMS, depending on their individual insurance coverage.

Earlier this year, CMS announced a drug pricing initiative and said that drug companies that raise prices faster than the rate of inflation would pay rebates to the federal government or be fined.

By reducing co-insurance for some people with Part B coverage and preventing drug companies from raising prices faster than inflation, the Medicare Prescription Drug Rebate Program can reduce out-of-pocket costs for some people with Medicare and reduce Medicare’s cost of expensive drugs, CMS said.​

BIG TREND

The Inflation Reduction Act, passed last year, contains several initiatives to lower drug prices in Medicare. By law, pharmaceutical companies that raise prices above the rate of inflation will pay rebates or penalties.

For the first time, Medicare may negotiate prices for 10 expensive yet-to-be-determined drugs starting in 2026. Beginning in 2025, Medicare recipients receive a $2,000 per year cap on out-of-pocket drug costs. Those with Medicare coverage receive a $35 monthly insulin limit.

IN RECORDING

“The Biden-Harris administration believes that people with Medicare should not be taken in by drug companies inexplicably overpricing their drugs,” said HHS Secretary Xavier Becerra. “President Biden has made reducing the cost of prescription drugs for Americans a top priority, and we are using every leverage we have to achieve results. Through the Inflation Rebate Program, we are fighting to ensure that older people can afford the care they need, taxpayers don’t subsidize overpriced pharmaceutical companies, and Medicare is strong for millions of beneficiaries now and in the future.”

Twitter: @SusanJMorse
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Salim Ismail will provide more details in his HIMSS23 presentation “Leaders Summit Keynote: Disruptive Convergence”. It is scheduled for Monday, April 17 from 3:45 pm to 4:30 pm PT at the Marriott Marquis Chicago Level 4 Grand Horizon Ballroom.