Letter to CMS Seeks Information on Lower Part B Coinsurance for Prescription Drugs Due to IRA-Created Price Gouging Penalty
Washington, D.C. – Senate Finance Committee Chair Ron Wyden (D-Ore.) and Senator Jon Tester (D-Mont.) joined 20 senators in a request to the Biden administration to publicize the effect of the Inflation Reduction Act’s Medicare Part B inflation rebate on coinsurance in the program.
“We strongly urge CMS to provide the following information quickly to help seniors in traditional Medicare and their families plan for lower cost-sharing on their Part B medications: (1) a list of the common names of Medicare Part B medications that will be subject to a coinsurance reduction on April 1, 2023; and (2) the percentage and amount of the coinsurance reduction for each Part B drug,” the senators wrote. “High Part B drug prices set by manufacturers place a heavy burden on Medicare beneficiaries, since patients pay 20 percent of the cost of these drugs… The IRA penalizes inflated drug prices and lowers Part B cost sharing to combat this financial burden.”
The letter, sent to Center for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, comes as the Biden administration continues to implement the Inflation Reduction Act’s drug pricing provisions. Last month, Wyden called on CMS to share details about its implementation of the Medicare Part D inflation rebate, and earlier the administration released details on its roadmap for implementing Medicare drug price negotiation.
The IRA protects Medicare beneficiaries who take Part B drugs (such as physician administered infusions and injections used to treat cancer and rheumatoid arthritis) if manufacturers continue price increases at rates that outpace inflation by reducing coinsurance for Medicare beneficiaries taking these same medications. Specifically, if the price Medicare faces for a Part B drug exceeds the amount that the drug would have cost if the manufacturer’s price only increased by the rate of inflation, then beginning April 1, 2023, a beneficiary’s coinsurance will be calculated based on 20 percent of the lower (inflation-adjusted) price. In other words, with implementation of the IRA’s Part B coinsurance reduction, beneficiaries who depend on costly clinic-administered medications will experience lower cost sharing if drug price increases outpace inflation. If the penalty is not applied, that means drug manufacturers did not increase their prices faster than inflation.
Joining Wyden and Tester on the letter were Senators Michael Bennet (D-Colo.), Amy Klobuchar (D-Minn.), Sherrod Brown (D-Ohio), Kirsten Gillibrand (D-N.Y.), Bob Casey (D-Penn.), Catherine Cortez Masto (D-Nev.), Ben Cardin (D-Md.), Tim Kaine (D-Va.), Richard Blumenthal (D-Conn.), Joe Manchin (D-W. Va.), Raphael Warnock (D-Ga.), Jeff Merkley (D-Ore.), Tammy Baldwin (D-Wis.), Mark Warner (D-Va.), Tom Carper (D-Del.), Peter Welch (D-Vt.), Sheldon Whitehouse (D-R.I.), Mark Kelly (D-Ariz.), Patty Murray (D-Wash.), and Chris Murphy (D-Conn.).
The full letter can be found here.
A web version of this release is here.
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