Negotiated Drug rebates will filter down to the Beneficiaries.

Meena Seshamani, M.D., Ph.D., deputy administrator and director of the Center for Medicare, said in a statement that CMS, through the prescription drug law, "continues to lower out-of-pocket drug costs for some people with Medicare by protecting them from sudden out-of-pocket cost increases when drug companies raise prices faster than the rate of inflation."

The Inflation Reduction Act mandates that pharmaceutical companies reimburse Medicare when the cost of certain pharmaceuticals provided to Medicare beneficiaries rises beyond the inflation rate. Beginning January 1, 2023, this new inflation rebate is applicable to Medicare Part B rebatable medications, which include single-source medications and biological goods, including some biosimilar biological products.

The federal government aims to send invoices to pharmaceutical companies for Part B inflation refunds for 2023 and 2024 no later than fall 2025. The Medicare Trust Fund will get the rebates. Additionally, Medicare beneficiaries may have decreased out-of-pocket expenses starting on April 1, 2023, for some Part B medications and biologicals whose costs have risen faster than the rate of inflation. The beneficiary's coinsurance will be 20% of the inflation-adjusted payment amount for these medications and biologicals, which is less than what the beneficiary would otherwise be required to pay in coinsurance.

The Medicare Part B Quarterly Sales Pricing (ASP) files, which are publicly accessible on CMS.gov, provide payment information that CMS posts each quarter for separately payable Part B medications, including the Part B rebatable drugs subject to the coinsurance adjustments. The Inflation Reduction Act mandates that the coinsurance adjustments for some Part B rebatable medications be included in the public files for the October 2023 ASP. A quarterly coinsurance modification may affect different Part B medications.

In the case of the following 34 Part B rebatable medications, they have an updated coinsurance rate based on the inflation-adjusted payment amount from October 1 through December 31, 2023. Depending on any other health insurance they may have, people with traditional Medicare and Medicare Advantage who use these prescriptions may pay less for their coinsurance during this particular quarter. Medicare recipients may incur coinsurance costs that are $1618 per typical dosage less than what they would have paid prior to the new law's passage during the three-month period from October 1 to December 31, 2023.

Below is the complete list of biological goods and prescription medications. Several of the medications on the most recent list are now subject to IRA regulation. Humira, Rybrevant, and Cresemba, among others, are medications for rheumatoid arthritis, lung cancer, and fungal infections.

Single-source pharmaceuticals and biological products are covered by the CMS rebate policy. Drug makers are to be invoiced by the federal government no later than fall 2025 into the Medicare Trust Fund, and the beneficiary coinsurance will be 20% of the inflation-adjusted payment amount for medications whose prices have increased faster than the rate of inflation.

HCPCS*: Drug Name; Inflation-Adjusted Coinsurance Percentage (Normally 20%)

• J9042 ADCETRIS (19.754%)
• J3246 AGGRASTAT (19.698%)
• J8655 AKYNZEO (17.996%)
• J7504 ATGAM (16.834%)
• J0558 BICILLIN CR (17.741%)
• J0561 BICILLIN L-A (17.484%)
• J9039 BLINCYTO (19.517%)
• J2850 CHIRHOSTIM (19.328%)
• J1833 CRESEMBA (19.997%)
• J0584 CRYSVITA (19.744%)
• J1645 FRAGMIN (13.158%)
• J0135 HUMIRA (19.997%)
• J1670 HYPERTET (19.207%)
• J9325 IMLYGIC (19.772%)
• J9198 INFUGEM (19.669%)
• J2820 LEUKINE (19.711%)
• J1950 LUPRON DEPOT-PED (19.895%)
• J2265 MINOCIN (18.828%)
• J9268 NIPENT (19.562%)
• J2796 NPLATE (19.935%)
• J9266 ONCASPAR (19.382%)
• J9177 PADCEV (19.229%)
• J1640 PANHEMATIN (19.536%)
• J9314 PEMETREXED (13.634%)
• J9318 ROMIDEPSIN (19.509%)
• J9061 RYBREVANT (19.908%)
• J2502 SIGNIFOR LAR (17.881%)
• C9482 SOTALOL (19.729%)
• J2860 SYLVANT (18.984%)
• J9262 SYNRIBO (19.378%)
• J2186 VABOMERE (19.554%)
• J9303 VECTIBIX (19.921%)
• J0775 XIAFLEX (18.626%)
• J0291 ZEMDRI (19.739%)

*The Centers for Medicare and Medicaid Services (CMS) created the Healthcare Common Procedure Coding System (HCPCS). The purpose was to form a group of uniform codes known as HCPCS are used to identify medical procedures, supplies, goods, and services.