The Inflation Reduction Act mandates drug companies to pay rebates to Medicare when prescription drug prices escalate faster than the inflation rate for certain drugs provided to Medicare beneficiaries. This new inflation rebate applies explicitly to Medicare Part B rebatable drugs, encompassing single-source drugs and biological products, including specific biosimilar biological products, effective January 1, 2023. The federal government aims to bill drug manufacturers for 2023 and 2024 Part B inflation rebates no later than the fall of 2025, with the rebates directed into the Medicare Trust Fund.
As of April 1, 2023, individuals enrolled in Medicare may observe reduced out-of-pocket expenses for certain Part B drugs and biologicals whose prices have surged faster than the inflation rate. The beneficiary coinsurance is 20% of the inflation-adjusted payment amount for these specific drugs and biologicals, significantly less than the typical coinsurance rate. CMS (Centers for Medicare & Medicaid Services) routinely publishes payment details each quarter for separately payable Part B drugs, including those subject to coinsurance adjustments under the Medicare Part B Quarterly Sales Pricing (ASP) files, publicly accessible on CMS.gov.
Notably, the Part B drugs affected by coinsurance adjustments may vary quarterly. For the April 1 – June 30 quarter, 41 Part B rebatable drugs across 45 Healthcare Common Procedure Coding System (HCPCS) codes feature an adjusted coinsurance rate based on the inflation-adjusted payment amount. During this time period, individuals enrolled in Medicare might encounter coinsurance amounts lower than previously expected due to the new legislation, potentially saving them anywhere from $1 to $3,575 per day.
This initiative reflects a concerted effort to mitigate the financial burden on Medicare beneficiaries. CMS typically releases ASP public files several weeks ahead of the quarter to allow notification of any discrepancies. Visit CMS.gov for further guidance about inflation rebates for Medicare.
Here’s the list of drugs with adjusted coinsurance amounts for the April 1 – June 30, 2024, quarter:
2024 Part B Rebatable Drugs
| Drug Names | Inflation-Adjusted Coinsurance Percentage (Normally 20.000%) |
|---|---|
| Abelcet | 19.92% |
| Adcetris | 19.29% |
| Akynzeo Capsule | 18.20% |
| Akynzeo IV | 19.73% |
| Argatroban (Accord) 1 | 16.76% |
| Argatroban (Accord) 1 | 16.76% |
| Argatroban (Auromedics) 1 | 7.47% |
| Argatroban (Auromedics) 1 | 7.47% |
| Atgam | 15.37% |
| Aveed | 19.14% |
| Bicillin C-R | 16.31% |
| Bicillin L-A | 16.25% |
| Blincyto | 19.79% |
| Chirhostim | 19.60% |
| Crysvita | 19.38% |
| Cytogam | 19.78% |
| Dysport | 18.88% |
| Envarsus Xr | 19.94% |
| Fosaprepitant (Teva) | 3.82% |
| Fragmin | 12.23% |
| Hypertet | 19.67% |
| Imlygic | 19.90% |
| Kepivance | 16.56% |
| Kymriah | 19.31% |
| Leukine | 19.59% |
| Lupron Depot-Ped | 19.51% |
| Meropenem (B Braun) | 9.54% |
| Minocin | 19.09% |
| Nexterone (Baxter) | 11.54% |
| Nipent | 19.85% |
| Oncaspar | 19.66% |
| Padcev | 18.89% |
| Panhematin | 19.84% |
| Prolia | 19.59% |
| Romidepsin (non-lyophilized) | 19.79% |
| Signifor LAR | 17.85% |
| Sotalol (Altathera) | 19.97% |
| Sylvant | 18.95% |
| Synribo | 19.70% |
| Tigan | 19.72% |
| Tigecycline (Accord) | 8.83% |
| Tivdak | 19.85% |
| Vabomere | 19.81% |
| Xiaflex | 18.56% |
| Zemdri | 19.91% |
Curious about how Medicare changes affect your clients’ costs? Reach out with any questions or for guidance on navigating these updates. Contact Carolina Senior Marketing at info@carolinaseniormarketing.com for assistance.
