Inflation Reduction Act (IRA) Medicare Drug Price Negotiation List Announced

Today, the Centers for Medicare & Medicaid Services (CMS) released the list of medicines it will start directly negotiating within Medicare Part D. This list is a result of a provision within the Inflation Reduction Act (IRA), which was signed into law by President Biden last year.

The Autoimmune Association applauds the Administration’s efforts to curtail patient spending at the pharmacy counter with provisions in the IRA that cap Medicare Part D out-of-pocket costs to $2,000 and allow for beneficiaries to spread these costs out over the year. However, we are concerned that the impact of Medicare drug price negotiations will not directly benefit patients.

The Autoimmune Association is steadfast in our advocacy efforts to reduce out-of-pocket costs for all patients and increase access to life-changing therapies our patients rely on. We are asking Congress and the Administration to focus on reforming policies that are increasing patient burden and out-of- pocket costs directly, like utilization management tactics and accumulator and maximizer programs.

Patients are spending approximately $35.8 billion annually in drug cost-sharing, even after utilizing financial support from manufacturers and philanthropic sources, a number that has jumped 10% in recent years. Physicians also spend approximately $26.7 billion in time navigating utilization management policies which in turn leads to patients experiencing delays in treatment that can damage their health and worsen their conditions overall. These policies are impacting patients every day and the Autoimmune Association will continue to work with all stakeholders to address these challenging concerns and bring a solution to our patient communities.

If you have been affected by an accumulator or maximizer program and would like to share your story, please contact us through this form. We are interested in hearing from you and learning about your experience.

Let My Doctors Decide publishes resources to help patients navigate insurer access barriers. Check out the organization’s patient-friendly guidebook with information on how to navigate these access barriers.

Key Terms

Accumulator program – A tactic by insurance companies that prevents any of the amounts that the patient has paid using manufacturer assistance from counting toward the patient’s out-of-pocket costs.

Maximizer program – A tactic by insurance companies that exhausts the maximum available patient assistance that a drug manufacturer offers to patients for prescription medicines, and does so in a manner that does not count that assistance toward patients’ annual cost-sharing limits.

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.

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.