What’s The Timeline for Implementation
Last year we reported on the federal Inflation Reduction Act (IRA), including several Medicare reforms that sought to address the increasing cost of prescription drugs. What our Medicare members want to know is when are these reforms being implemented.
INSULIN: One of them has already been implemented this year to mitigate the cost of insulin. Studies show that the average retail price of insulin rose an alarming 54% from January 2014 to April 2019. Even with a slight downward price trend of 7.1% from January 2020 to January 2023, there has remained an urgent need to curb insulin’s cost for approximately 8.3 million nationally who need to use it to regulate their blood glocuse levels.
Beginning this January, the IRA established a $35 monthly cap for retirees who are covered by a Medicare prescription drug plan. That includes our members who are insured by one of the state GIC’s Medicare plans, as well as our local members who are enrolled in a group Medicare supplement plan provided by their former public employer (city, town, district, authority, etc.).
For these retirees to pay no more than $35 for a month’s supply, they must first make certain that the insulin they are taking is covered by their prescription drug plan and is dispensed by a pharmacy or mail-order pharmacy.
Bottom line, please check with your plan. And, if you get a 2- or 3-month supply of a covered insulin, your insulin cost can’t exceed $35 each month.
And if your insulin is covered and you already paid more than $35 for a month’s monthly prescription earlier this year, you should receive reimbursement within 30 days from your plan. Otherwise, contact your plan to be reimbursed.
VACCINES: Also beginning this January, adult vaccines, recommended by the Advisory Committee on Immunization Practices (ACIP) are available to members at no cost. To be eligible, you must beinsured by one of the state GIC’s Medicare plans or be enrolled in a group Medicare supplement plan provided by one’s former public employer (city, town, district, authority, etc.).
By way of background, the ACIP is a committee within the federal Centers for Disease Control and Prevention that provides advice and guidance on effective control of vaccine-preventable diseases in the general population. The ACIP develops written recommendations for routine administration of vaccines to the pediatric and adult populations, along with vaccination schedules regarding appropriate timing, dosage and contraindications of vaccines. ACIP statements are official federal recommendations for the use of vaccines and immune globulins in the U.S., and are published by the CDC.
It must be noted here that the listing of ACIP vaccine recommendations is very comprehensive and beyond the scope of this report. Diseases, such a COVID-19, Hepatitis A & B, Influenza, Measles, Mumps, Rubella, Pneumococcal, Polio and Shingles are contained in the listing. We suggest that you contact your insurance plan and/or vaccine provider to confirm that your vaccine is on the ACIP listing.
DRUG PRICE NEGOTIATION PROGRAM: IRA created the Medicare Drug Price Negotiation Program whereby Medicare will be able to negotiate directly with drug manufacturers to lower the price of some of the costliest single-source brand-name Medicare Part B and Part D drugs.
By this coming September 1 the federal Centers for Medicare & Medicaid Services (CMS) will select the first 10 Medicare Part D drugs for the Drug Price Negotiation Program.
The maximum fair prices that are negotiated for these drugs will be announced in 2024 and apply beginning in 2026. The drug selection and price negotiations will be repeated with an additional 15 Part D drugs selected in both 2025 and 2026 to take effect for 2027 and 2028 respectively, and then an additional 20 Part B or Part D drugs in 2027, 2028 and 2029 to take effect in 2029, 2030 and 2031 respectively.
CMS will be announcing their drug selection after we go to press. We will keep members updated on this in our weekly message, Hotline and website.