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CMS Estimates Savings for Patients from Medicare Inflation Rebates
Medicare Part B beneficiaries may save between $1 and $3,575 per average dose for the 41 drugs whose prices have risen higher than inflation.
In the second quarter of 2024, the U.S. Department of Health and Human Services (HHS) predicts that an estimated 763,700 people with Medicare Part B will benefit with lowered coinsurance as a result of the inflation rebates required on prescription drugs because of the Inflation Reduction Act.
Between April 1, 2024, and June 30, 2024, beneficiaries may save between $1 and $3,575 per average dose depending on coverage for the 41 drugs (listed below) subject to rebates through Part B whose prices have risen faster than the rate of inflation.
The Inflation Reduction Act requires drug companies to pay rebates to Medicare when prices increase faster than the rate of inflation for certain drugs. The Centers for Medicare & Medicaid Services intends to begin invoicing prescription drug companies for rebates owed to Medicare no later than fall 2025. The rebate amounts paid by drug companies will be deposited in the Federal Supplementary Medical Insurance Trust Fund, which will help ensure the long-term sustainability of the Medicare program for future generations.
List of drugs subject to Inflation Rebate
- Abelcet (amphotericin B lipid complex injection): fungal infections, Leadiant Biosciences
- Adcetris (brentuximab vedotin: Hodgkin lymphoma and large cell lymphoma; Seagen/Pfizer
- Akynzeo Capsule (netupitant/palonosetron): chemotherapy induced nausea; Helsinn
- Akynzeo IV (netupitant/palonosetron): chemotherapy induced nausea; Helsinn
- Argatroban (Accord) with HCPCS code J0891: anticoagulant
- Argatroban (Accord) with HCPCS code J0892: anticoagulant
- Argatroban (Auromedics) with HCPCS code J0898: anticoagulant
- Argatroban (Auromedics) with HCPCS code J0899: anticoagulant
- Atgam (immune globulin): aplastic anemia; Pfizer
- Aveed (testosterone): hormone replacement; Endo
- Bicillin C-R (penicillin G benzathine, penicillin G procaine): infections; Pfizer
- Bicillin L-A (penicillin G benzathine): infections; Pfizer
- Blincyto (blinatumomab): acute lymphoblastic leukemia; Amgen
- Chirhostim (hormone): diagnosis of pancreatic dysfunction and cancer; ChiRhoClin
- Crysvita (burosumab-twza): X-linked hypophosphatemia; Kyowa Kirin
- Cytogam (cytomegalovirus immune globulin); to prevent CMV after organ transplant; Kamada
- Dysport (abobotulinumtoxinA): frown lines; Galderma
- Envarsus XR (tacrolimus): to prevent organ rejection; Veloxis Pharmaceuticals
- Fosaprepitant (Teva): nausea and vomiting
- Fragmin (dalteparin): blood thinner; Pfizer
- Hypertet (tetanus immune globulin): prevention of tetanus; Grifols
- Imlygic (talimogene laherparepvec): melanoma; Amgen
- Kepivance (palifermin): to reduce mucositis after chemotherapy; Sobi
- Kymriah (tisagenlecleucel): acute lymphoblastic leukemia; Novartis
- Leukine (sargramostim): bone marrow stimulant; Partner Therapeutics
- Lupron Depot-Ped (leuprorelin): endometriosis, prostate cancer; AbbVie
- Meropenem (B Braun): bacterial infections
- Minocin (minocycline): infections; Torrent Pharmaceuticals
- Nexterone (amiodarone) (Baxter): for heart rhythm problems
- Nipent (pentostatin): leukemia; Pfizer
- Oncaspar (pegaspargase): acute lymphoblastic leukemia; Servier
- Padcev (enfortumab vedotin): bladder cancer; Astellas and Seagen/Pfizer
- Panhematin (hemin): porphyria: Recordati Rare Diseases
- Prolia (denosumab): osteoporosis; Amgen
- Romidepsin (non-lyophilized) T-cell lymphoma
- Signifor LAR (pasireotide): acromegaly and Cushing’s; Recordati Rare Disease
- Sotalol (altathera): arrhythmias
- Sylvant (siltuximab): Castleman’s disease; Recordati Rare Diseases
- Synribo (omacetaxine mepesuccinate): chronic myeloid leukemia; Teva
- Tigan Tigecycline (Accord): antimicrobial
- Tivdak (tisotumab vedotin): cervical cancer; Genmab and Seagen/Pfizer
- Vabomere (meropenem and vaborbactam): urinary tract infections and hospital acquired pneumonia; Melinta
- Xiaflex (collagenase clostridium histolyticum): Peyronie’s disease and Dupuytren’s contracture; Endo
- Zemdri (plazomicin): urinary tract infections; Cipla Therapeutics
Payers Recognize the Benefits, but Still See Weight Loss Drugs through a Cost Lens
April 12th 2024Jeffrey Casberg, M.S., R.Ph., a senior vice president of clinical pharmacy at IPD Analytics LLC, a drug intelligence firm that advises payers and pharmaceutical companies, talks about how payers are thinking about weight-loss drugs.
