Health Plan Weekly

With IRA Drug Prices Set, Jury Is Out on How Part D Plans Will Counter

  • Aug 16

    Aug 16, 2024

    When CMS on Aug. 15 revealed the prices of the 10 drugs subject to Medicare price negotiation, its much-anticipated disclosure still left many questions unanswered. In the managed care world, the biggest question mark remains how Medicare Part D plans will adjust their formularies in reaction to the new government-set prices — but one industry expert says it will be a while before more clarity emerges. 

    “These prices are effective Jan. 1, 2026, so they should not, in theory, impact the 2025 formularies,” which have been largely decided since April, says Jennifer Snow, founder of the health policy and reimbursement consulting firm Apteka LLC.  

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    • Leslie Small

    Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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Drug Pricing
Legislation & Regulation
Medicare Part D
Reimbursement
Benefit Design
PBMs/Pharmacy Benefit Managers
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