The Inflation Reduction Act (IRA) was signed into law on August 16th, 2022. The law includes provisions that are focused on lowering prescription drug costs for people with Medicare and reducing costs to the Federal Government. These regulations include a redesign of the Part D program for 2025, which is described below.
On April 1,2024 The Centers for Medicare & Medicaid Services (CMS) announced a 3.7% increase in payments to insurers. This is significantly lower than initially anticipated and does not account for inflation.
For 2025, there will be changes to the Part D program as a result of the Inflation Reduction Act, impacting both stand-alone Part D and Medicare Advantage Prescription Drug Plans. It is important that you are informed on these changes to help understand how you may be impacted.
| 2023 | 2024 | 2025 |
| -$0 cost-sharing for adult vaccines -$35 cap on Part D Insulin cost-share (Part D Start: 1/2023 Part B Start: 7/2023) -Inflationary rebates for Parts B and D (Start: 10/2022) | -Pharmacy network DIR at point-of-sale changes -Annual increase in national average premium cap (through 2029) -Expansion of low-income cost-sharing and premium subsidy eligibility (from 135% FPL to 150% FPL) -Member pays $0 in the Catastrophic stage | -Part D Benefit Redesign: Elimination of the Coverage Gap (“donut hole”) -Reallocation of costs in the Catastrophic stage –$2,000 maximum true out-of- pocket (TrOOP) -New Manufacturer Discount Program -Medicare Prescription Payment Plan |
A 10-20% mandatory discount from prescription manufactures during a beneficiary’s initial and catastrophic coverage phases. This discount will be waived if other discounts are applied, such as Good Rx. The MDP is built into the prescription price and may not be reflected on EOBs or receipts. Discounts do not apply to the TrOOP calculation.
CMS has introduced the Medicare Prescription Payment Plan offering members the option to pay $0 at the point-of-sale, and instead, pay for their prescriptions through a monthly payment program during the calendar year. This program applies to stand-alone Prescription Drug plans and Medicare Advantage plans with prescription drug coverage.