Applicable January 1 – March 31, 2024
President Biden’s historic Inflation Reduction Act requires drug companies to pay rebates to Medicare when prescription drug prices increase faster than the rate of inflation for certain drugs furnished to people with Medicare. This new inflation rebate applies to Medicare Part B rebatable drugs, which are single source drugs and biological products, including certain biosimilar biological products, beginning January 1, 2023.
The federal government intends to invoice drug manufacturers for 2023 and 2024 Part B inflation rebates no later than fall 2025. The rebates will be deposited into the Medicare Trust Fund. In addition, beginning April 1, 2023, people with Medicare may see lower out-of-pocket costs for certain Part B drugs and biologicals with prices that have increased faster than the rate of inflation. For these drugs and biologicals, the beneficiary coinsurance will be 20% of the inflation-adjusted payment amount, which will be less than what the beneficiary would pay in coinsurance otherwise.
CMS posts payment information each quarter for separately payable Part B drugs, including the Part B rebatable drugs subject to the coinsurance adjustments, in the Medicare Part B Quarterly Sales Pricing (ASP) files, which are publicly available on CMS.gov. The January 2024 ASP public files will also include the coinsurance adjustments for certain Part B rebatable drugs as required by the Inflation Reduction Act. The Part B drugs impacted by a coinsurance adjustment may change quarterly.
For the time period of January 1 – March 31, 48 Part B rebatable drugs in 49 Healthcare Common Procedure Coding System (HCPCS) codes have an adjusted coinsurance rate based on the inflation-adjusted payment amount. People with Traditional Medicare and Medicare Advantage who use these drugs may, depending on other health coverage they may have, pay a reduced amount for their coinsurance during this specific quarter. For the quarter, January 1 –March 31, people with Medicare may experience coinsurance amounts that are lower than what they would have paid before the new law passed by as much as $1-$2,786 per day.
CMS’ normal procedure is to release the ASP public files several weeks before the quarter they will go into efect so the public can review and notify CMS of any potential discrepancies. From time to time, ASP public files need to be corrected or updated, generally referred to as a restatement, based on feedback received afer the files are published. If CMS receives feedback that necessitates updates to this list of drugs with adjusted coinsurance amounts, CMS will update the list. The January 1 – March 31, 2024 files may be subject to updates either before the start of the quarter or after in the event updated data becomes available.
Below is the list of drugs with adjusted coinsurance amounts for the quarter January 1 – March 31, 2024. Learn more about the Medicare Prescription Drug Inflation Rebate Program including a fact sheet on the Part B rebatable drug coinsurance reduction.
SOURCE: CMS.gov
