Recently, the Centers for Medicare and Medicaid Services (CMS) announced a third set of Medicare Part B prescription drugs that will have a reduced coinsurance amount, from October 1, 2023, through December 31, 2023. The thirty-four drugs in the set are reduced in price via the Medicare Prescription Drug Inflation Rebate program in the Inflation Reduction Act, through lower coinsurance amounts for Medicare beneficiaries with Part B coverage.
According to CMS, beneficiaries who take the drugs included on the list may save between $1 and $618 per average dose during these three months, depending on their individual coverage. Additionally, many of the drugs included on the list have been on the list in prior quarters this year, including Humira (rheumatoid arthritis), Rybrevant (lung cancer), and Cresemba (fungal infection).
Also included on the list are Adcentris (an antibody drug conjugate for certain CD30-expressing lymphomas, such as previously untreated Stage 3 or 4 classical Hodgkin lymphoma); HyperTET (tetanus); Oncaspar (acute lymphoblastic leukemia); and Vabomere (complicated UTI).
CMS only releases the drugs a few weeks prior to the effective quarter, so that the public can review and notify the agency of any discrepancies noticed. As we’ve seen this year, the Part B drugs impacted by the quarterly coinsurance adjustment are subject to change each quarter.
Under the Inflation Reduction Act, drug companies are required to pay rebates to Medicare when prices for certain prescription drugs covered under Part B increase faster than the rate of inflation. Medicare makes health care providers whole by paying the difference between the Medicare-allowed amount and the adjusted beneficiary coinsurance.
“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. “This is just one of the many ways we are helping to strengthen Medicare now and in the future.”
A complete list of the drugs with reduced coinsurance for October 1, 2023, through December 31, 2023, click here.
For a Fact Sheet about the Medicare Prescription Drug Inflation Rebate Program Part B Rebatable Drug Coinsurance Reduction, click here.
Guidance outlining the requirements and procedures for the Medicare Prescription Drug Inflation Rebate Program can be found here.