Inflation Reduction Act Fact Sheet Outlines Important Changes for 2023 and Beyond

A new Centers for Medicare & Medicaid Services (CMS) fact sheet outlines key Inflation Reduction Act (IRA) Medicare changes and effective dates.

Key prescription drug affordability highlights include:

2023 — Insulin will be limited to $35 for a month’s supply. This takes effect January 1 for insulin covered under Part D and July 1 for insulin covered as durable medical equipment under Part B.
2024 — Low-income assistance will be expanded to people with income at or below 150% of the federal poverty level.
2025 — Part D enrollees will have their out-of-pocket drug costs capped at $2,000. They will also have the option to pay these costs in monthly amounts rather than all at once.

CMS also explains the IRA’s Part D structural changes:

2024 — People who reach the Part D catastrophic phase will no longer have to pay cost-sharing.
2025 — The Manufacturer Discount Program in Medicare Part D will replace the Medicare coverage gap discount program. In general, it will require drug manufacturers to pay a 10% discount on certain drugs in the initial coverage phase and a 20% discount in the catastrophic phase. Government reinsurance in the catastrophic phase will decrease from 80% to 20% for most brand-name drugs and from 80% to 40% for generics.

And the initial Medicare negotiation implementation timeline:

2023 — CMS will announce the first 10 Part D drugs to be negotiated. They must be among the highest-spending, brand-name drugs that don’t have competition.
2024 — CMS will publish the negotiated prices for these drugs.
2025 — Medicare will negotiate prices for 15 more Part D drugs.
2026 — The negotiated prices for the first 10 Part D drugs will take effect. This is the first year people with Medicare will see the direct impacts of negotiation. CMS will select another 15 drugs—under Part D or Part B—for negotiation.
2027 — Negotiated prices for the 15 Part D drugs selected in 2025 will kick in. Each round is cumulative, adding to the total number of drugs with negotiated prices. CMS will announce 20 more Part B or Part D drugs for negotiation.

In subsequent years, CMS will continue negotiating prices, which will take effect two years later:

2028 — Prices for the 15 drugs selected in 2026 will go into effect. CMS will announce 20 more Part B or Part D drugs for negotiation.
2029 — Prices for the 20 drugs selected in 2027 will go into effect. CMS will announce 20 more Part B or Part D drugs for negotiation.
2030 — Prices for the 20 drugs selected in 2028 will go into effect.
2031 — Prices for the 20 drugs selected in 2029 will go into effect.

View the CMS timeline and frequently asked questions about these changes.