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CMS Inflation Reduction Act Implementation Timeline

2022:

  • 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.

2023:

  • 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

2024:

  • 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

2025:

  • 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

2026:

  • 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

2027

  • 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

2028

  • 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

2029

  • 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

 

Download the full implementation timeline from CMS here: 10.5.22 Inflation Reduction Act Timeline-Updated-V1-508 (1)

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