Medicare announces lower out-of-pocket drug costs for some beneficiaries

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Prescription drug prices may be lower for some Medicare beneficiaries in the fourth quarter due to price rebates required by the federal Inflation Reduction Act (IRA).

However, congressional lawmakers are examining if government price controls are stifling innovations that could lead to better patient care.

The U.S. Centers for Medicare & Medicaid Services announced 34 prescription drugs that will have lower coinsurances for beneficiaries using Medicare Part B, Oct. 1 to Dec. 31. Some patients could save up to $618 per average dose, depending on their coverage.

“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,” CMS Deputy Administrator and Medicare Center Director Meena Seshamani, MD, PhD, said in a news release. “This is just one of the many ways we are helping to strengthen Medicare now and in the future.”

The IRA aimed to reduce coinsurance for some people with Part B coverage and discourage drug companies from increasing prices faster than inflation, according to CMS. The drugs and biological product costs were included in the quarterly Average Sales Price (ASP) public files published quarterly.

CMS’ normal procedure is to release those ASP public files for review several weeks before the quarter they go into effect. The ASP public files may be changed based on public feedback.

Prices vs. patients

The CMS announcement followed last month’s publication of the first 10 drugs that Medicare will begin negotiating prices for, to take effect in 2025. The Congressional Budget Office has estimated dickering for drug prices will save Medicare close to $100 billion in the next 10 years.

The concept has broad support from the public, but basically zero support from pharmaceutical companies suing to stop the price talks.

Also this week, the U.S. House of Representatives’ Energy & Commerce Committee announced a Subcommittee on Oversight and Investigations hearing about market effects of the IRA and price controls.

House Energy and Commerce Committee Chair Rep. Cathy McMorris Rodgers (R-Washington) and Subcommittee on Oversight and Investigations Chair Rep. Morgan Griffith (R-Virginia) announced a joint statement about the hearing titled “At What Cost: Oversight of How the IRA's Price Setting Scheme Means Fewer Cures for Patients.”

"Patients across America are relying on medical innovators to develop new treatments and cures. Since the so-called 'Inflation Reduction Act' was signed into law by President Biden, at least two dozen drug makers have scaled back their research and development priorities, raising concerns about the future availability of innovative treatments,” their statement said.

“In addition to the law’s chilling effect on medical innovation, the act's ‘negotiation’ provisions have sparked significant constitutional debates, with several challenges currently under legal review,” the legislators said. “This hearing will give our members an opportunity to hear from experts and stakeholders about how the law has already affected new treatments and cures for patients and what we might expect in the coming months.”