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Autoimmune Association Applauds Key Patient Protections Included in the Inflation Reduction Act; Works to Address Concerns

President Biden has signed the Inflation Reduction Act passed by Congress that enacts crucial patient protections for those covered by Medicare. These protections will ensure seniors with autoimmune, immune-mediated, and general chronic conditions can afford the care they need.

The enacted Inflation Reduction Act includes the following provisions:

  • Caps Medicare Part D annual out-of-pocket costs to $2,000, beginning in 2025
  • Provides a smoothing mechanism to spread out-of-pocket costs throughout the plan year, beginning in 2025
  • Eliminates any patient cost-sharing in the catastrophic phase, beginning in 2024.

While we celebrate this step toward meaningful reform in Medicare Part D, we are aware that the Inflation Reduction Act is a broad bill that includes other health care provisions, the impact of which is less clear. Concerns include the role of pharmacy benefit managers, the impact on innovation, the potential increase in the cost of our country’s healthcare system, and the role of utilization management protocols that delay access to care.

The Autoimmune Association will continue to work with all stakeholders to address these challenging concerns and bring a solution to our patient communities.

Key Terms:

  • Medicare Part D – A federal government program that help seniors and people with long-term disabilities who are Medicare beneficiaries pay for self-administered prescription drugs.
  • Pharmacy Benefit Managers – Corporations that administer drug prescription plans for insurance companies; they manage high-cost specialty medication. They help to control what medications are available, which can potentially restrict access for patients.
  • Utilization Management Protocols – The use of managed care techniques such as prior authorization and step therapy that allow insurance companies to manage the cost of healthcare by assessing whether patients can receive necessary medication that their physicians have prescribed.
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