Lower Out-Of-Pocket Costs for 34 Medicare Part B Drugs

Inflation rebates will reduce out-of-pocket costs for 34 prescription drugs covered under Medicare Part B, potentially allowing beneficiaries to save up to $618 per average dose.

Through the Inflation Reduction Act (IRA), Part B beneficiary coinsurances may be lower between October 1 – December 31, 2023. The CMS estimates that some people will save between $1 and $618 per dose on average, depending on their individual coverage.

The IRA requires drug companies to pay rebates to Medicare when certain single-source and biosimilar prescription drug prices increase faster than the inflation rate.

As some beneficiaries will pay less in coinsurance, Medicare will make health care providers whole by paying the difference between the Medicare allowed amount and the adjusted beneficiary coinsurance, according to the CMS fact sheet.

“CMS, through the prescription drug law, continues to lower out-of-pocket drug costs for some people with Medicare by protecting them from sudden out-of-pocket cost increases when drug companies raise prices faster than the rate of inflation,” said Dr. Meena Seshamani, Deputy Administrator and Director of the Center for Medicare, in a statement.

The list includes medications for cancer like Adcetris, Synribo, and Rybrevant; drugs to alleviate side effects of chemotherapy, such as Akynzeo; blockbuster medication for autoimmune diseases Humira; and antibiotics, including Bicillin C-R, Bicillin L-A, and Minocin, among others.

The IRA allows Medicare, for the first time, to directly negotiate the prices of certain drugs that have high total spending and are high-expenditure, single-source drugs without generic or biosimilar competition.

The list of the first 10 medications covered under Medicare Part D selected for negotiations includes diabetes drugs, blood thinners, and medications for autoimmune conditions.