Medicare: Some seniors could start paying less for certain drugs whose prices are rising faster than inflation


Starting next month, some Medicare beneficiaries will pay less out-of-pocket costs for 27 prescription drugs whose prices have risen faster than inflation late last year, the U.S. Department of Health and Human Services said Wednesday.

This announcement serves as president biden highlight his Efforts to Lower Americans’ Daily Expenses Among higher-than-expected inflation.

Seniors could see their cost-sharing drop by $2 to $390 per average dose, and the drugs are used by patients with a variety of cancers, fungal infections, acne, rheumatoid arthritis, chronic kidney disease and urinary tract infections, among other conditions. Drugs covered by Medicare Part B are administered by a physician.

HHS Secretary Xavier Becerra said the list of drugs eligible for rebates will be updated quarterly.

How much a Medicare beneficiary will save depends on a variety of factors, including whether they have supplemental insurance and what their treatment options are. Seniors typically pay 20% of the cost of Medicare-approved drugs as coinsurance.

Cost savings come from providing Inflation Reduction Act, Congressional Democrats passed the bill last August. It requires drug companies to pay Medicare rebates if they raise prices faster than inflation.

Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services, said the measure would also provide a “strong incentive” to keep drugmakers from raising prices. Prices for about 1,200 prescription drugs will rise faster than inflation in 2021, according to a recent HHS report.

“I would say it’s kind of a double benefit — one, if the pharmaceutical companies do beat inflation, they’re going to pay the federal government a rebate,” she said Tuesday. “But I would say that equally important is the incentive for pharmaceutical companies not to increase costs, which we saw with the Medicaid inflation rebate, which is now a much stronger tool.”

Some 3.4 million Medicare beneficiaries would have saved $234 million in out-of-pocket costs on the 2021 vaccine — or an average of $70 per person — Inflation Reduction Act The rules were then in effect, according to a new HHS report. Beginning in January, the law mandates that older adults get free recommended Part D vaccines, including those against shingles and tetanus.

The agency expects more seniors to benefit from the measure this year.

In addition, CMS is expected to issue preliminary guidance on its drug price negotiation process, which will outline how the agency will select drugs and conduct negotiations.

this Inflation Reduction Act Authorizes Medicare to negotiate the price of certain expensive drugs that are used in a doctor’s office or purchased for the first time at a pharmacy.

The HHS secretary can negotiate prices for 10 drugs in 2026, and another 15 in 2027 and 2028. This number will increase to 20 drugs per year by 2029 and beyond. Only drugs that have been on the market for many years without competition are eligible.

The agency’s announcement comes as Novo Nordisk becomes the latest company to announce it will cut the price tag Its several insulin products.

Beginning this year, the Lower Inflation Act reduced the out-of-pocket cost of insulin for Medicare beneficiaries to $35 per prescription per month. But Republicans blocked a measure that would have extended the price cap to private insurance coverage.

Biden and congressional Democrats have been pressuring insulin makers to lower prices, which would benefit diabetics who do not qualify for Medicare.

Earlier this month, Lilly announced a series of price cuts This would reduce the price of the most commonly used form of insulin by 70%. Eli Lilly also said it would automatically limit out-of-pocket insulin costs to $35 for people with private insurance and using participating pharmacies, and expand its Insulin Value program, which limits out-of-pocket costs to $35 or more Less than a month for the uninsured.

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