Affordable Care Act
- People covered under ACA insurance plans continued to save on insurance coverage during Open Enrollment for 2023 coverage
Medicare Part B qualifying biosimilars
- Starting October 1, 2022, Medicare began temporarily paying an add on fee of 8% instead of 6% for qualifying biosimilars to encourage competition, lower drug costs, and increase access
Medicare Part D drug rebates
- October 1, 2022 was the start of the first 12 month period for which drug manufacturers were require to pay rebates to Medicare if their prices for some Part D drugs were hiked higher than the rate of inflation over the 12 month period.

Insulin cost-sharing
- Starting January 1, 2023, people enrolled in a Medicare prescription drug plan no longer had to pay more than $35 per month for each insulin they take and is covered by their Medicare plan. Part D deductibles no longer apply to the covered insulin product.
- Starting July 1, 2023, people with Traditional Medicare who take insulin through a traditional pump no longer pay more than $35 for a month’s supply of insulin
Vaccine cost-sharing
- As of October 1, 2023, recommended adult vaccines, including the shingles vaccine, became available to most adults with coverage from Medicaid, Medicare Part D, and CHIP no cost to them
Medicare Part B drug rebates
- January 1, 2023 was the start of the first quarter for which drug manufacturers were required to pay rebates to Medicare if prices for some Part B drugs increased faster than the rate of inflation
Coinsurance for Part B drugs
- Starting April 1, 2023, people with Traditional Medicare pay a lower coinsurance for some Part B drugs if Pharma companies hiked the prices faster than the rate of inflation
Medicare Part D drugs selected for the Drug Price Negotiation Program
- On August 29, 2023, CMS announced the first 10 drugs selected for lower negotiated prices

Catastrophic phase of the Medicare prescription drug benefit
- Starting January 1, 2024, people with Medicare prescription drug coverage who fall into the catastrophic phase of the Rx drug benefit won’t have to pay any coinsurance or co-payments during that phase for covered Medicare prescription drugs
Part D premium stabilization
- Beginning January 1, 2024, the average premium increase across most Part D plans can be limited to 6% over the previous year; this protection continues through 2029.
Low-Income Subsidy Program
- Low-income individuals with Medicare Part D will benefit from expanded financial help with prescription drug cost-sharing premiums. The program will be fully available to certain people with Medicare with limited resources who earn less than 150% of the federal poverty level starting in 2024
Cap on Part B payment for new biosimilars
- Starting July 1, 2024 there will be a cap on the Part B payment amount for new biosimilars when average sales price data is not available
Drug Price Negotiation Program
- By September 1, CMS will publish the maximum fair prices negotiated for the first 10 Medicare Part D drugs selected for negotiation. The maximum fair prices for these first 10 drugs will go into effect in 2026

Out-of-pocket limit in Part D
- People with Medicare Part D won’t pay more than $2,000 per year out-of-pocket for prescription drugs
Manufacturer Discount Program
- The Manufacturer Discount Program in Medicare Part D will replace the Medicare coverage gap discount program; this will require manufacturer discounts for applicable drugs
Government reinsurance
- Government reinsurance in the catastrophic phase of Part D will decrease from 80% to 20% for brand-name drugs, biologicals, and biosimilars and will decrease from 80% to 40% for generics
Drug Price Negotiation Program
- By February 1, 2025, CMS will announce 15 more drugs for negotiation
- By November 30, 2025, CMS will publish the maximum fair prices for the 15 Medicare Part D drugs selected

Additional drugs selected for Drug Price Negotiation
- Maximum fair prices for the first 10 drugs selected for negotiation will go into affect
- By February 1, 2026, CMS will announce 15 more drugs for negotiation in Medicare Part B or Part D
- By November 30, CMS will publish the maximum fair prices for the 15 Part B or Part D drugs selected for negotiation
Government reinsurance with respect to Selected Drugs in their Applicability Period
- Beginning in 2026, government reinsurance in the catastrophic phase of Part D will be 40% for Medicare Part D drugs selected for negotiation

Additional drugs selected for price negotiation
- Maximum fair prices for the 15 drugs selected for negotiation in 2025 will go into effect
- By February 1, 2025, CMS will announce 20 more Part B or Part D drugs for negotiation
- By November 30, 2025, CMS will publish the maximum fair prices for the drugs selected

Additional drugs selected for price negotiation
- Maximum fair prices for the 15 drugs selected for negotiation in 2026 will go into effect
- By February 1, 2025, CMS will announce 20 more Part B or Part D drugs for negotiation
- By November 30, 2025, CMS will publish the maximum fair prices for the drugs selected

Additional drugs selected for price negotiation
- Maximum fair prices for the 20 drugs selected for negotiation in 2027 will go into effect
- By February 1, 2025, CMS will announce 20 more Part B or Part D drugs for negotiation
- By November 30, 2025, CMS will publish the maximum fair prices for the drugs selected

Thank You for standing with us to put people before Pharma Profits!

Join our campaign, endorse our principles