CMS Unveils New List of Drugs Subject to Medicare Part B Inflation-Based Rebates

CMS on June 9 revealed a list of 43 Medicare Part B drugs that will be sanctioned for having their prices increase faster than the rate of inflation, as part of the Inflation Reduction Act (IRA). The number of drugs affected is almost double the number that made CMS’s initial list, which the agency made public in March. Starting in July, beneficiaries who normally pay 20% coinsurance under Part B for the 43 drugs will see their cost sharing decline based on an inflation-adjusted price. The federal government will invoice manufacturers for 2023 and 2024 Part B inflation rebates no later than fall 2025, and those funds will be deposited into the Medicare Trust Fund.

Seven of Amgen, Inc.’s medications made the list, including its blockbuster bone density medication Prolia, cancer medications Kyprolis, Vectibix and Blincyto, and Nplate for immune thrombocytopenia.

Prolia cost the Part B program more than $1.7 billion in 2021, with an average cost per beneficiary exceeding $2,800. For Crysvita, a monoclonal antibody to treat X-linked hypophosphatemia, the average spending per beneficiary reached over $201,000 in 2021. For most of the drugs listed, most people covered by Medicare formularies have plans that put these drugs under covered or covered with prior authorization and/or step therapy tiers, according to data from MMIT Analytics. (MMIT is AIS Health’s parent company.)

According to CMS, Medicare enrollees who take one of the 43 drugs will now save between $1 and $149 per average dose starting July 1, depending on their individual coverage.

A new report from HHS’s Office of the Assistant Secretary for Planning and Evaluation showed that Medicare fee-for-service Part B drugs had the fastest rate of spending growth among drugs in the Medicare program from 2008 to 2021. Part B drug spending per enrollee increased 9.2% annually during that period, which was over three times higher than the growth in spending on Part D drugs and nearly four times as much as the per capita annual increase in prescription drug spending across all payers.

Part B spending was highly concentrated, with the top 10 drugs accounting for 40% of spending in 2021. Among the 20 drugs associated with the highest spending, all of which are biologics, only Prolia was included in the latest Part B inflation rebate list.

The report concluded that the incentives associated with the current payment methodology are not consistent with the provision of high-value care to beneficiaries. Several IRA provisions such as inflation rebates, temporary higher reimbursements for biosimilars, and drug price negotiations may provide tools to slow down the rapid rate of growth in Part B drug spending.

This infographic was reprinted from AIS Health’s biweekly publication RADAR on Drug Benefits.