Medicare Part D Redesign Will Sharpen Policy Focus on Protected Classes
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Jul 06, 2023
Upcoming changes in the Medicare Part D benefit that involve increasing the risk borne by insurers in the catastrophic phase may boost pressure on plans to control costs in the six protected classes, and manufacturers are worried about what that might lead to.
Under the Inflation Reduction Act, Part D plan obligations for drug costs will increase from 15% to 60% in the catastrophic phase beginning in 2025, while Medicare’s will decrease from 80% to 20% for brands.
Manufacturers will supplement coverage in the catastrophic phase with a new 20% mandatory discount on brands but plans are still expected to look for ways to lower drug spending because they won’t be able shift costs to enrollees in the usual ways. As part of the redesign, cost sharing will be capped at $2,000 a year and annual premium increases will be limited.
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