March 9, 2023
The Inflation Reduction Act (IRA) means several pharmacy/medical benefit changes for Medicare Advantage prescription drug members. Many of these changes took effect January 1, 2023. Stay tuned as the Centers for Medicare & Medicaid Services (CMS) roles out more changes through 2028.
Insulin cap
The IRA includes more insulin cost savings for 2023.
- Members will pay $2 to $35 for a month's supply of non-pump insulins
- Beginning July 1, 2023, traditional pump-covered insulin will be $35 for a month’s supply through all phases of coverage.
$0 vaccines
Members can now get flu, pneumonia, shingles, tetanus-diphtheria-whooping cough (Tdap), and hepatitis B vaccines at $0 cost share. Members won’t pay any fees associated with the vaccines.
CMS also created criteria making additional vaccines eligible at $0 cost share. To qualify, the vaccine must be:
View the full list of available vaccines.
Eligible Part B Drug Coinsurance Reduction
Select Part B drugs administered by a healthcare professional will have a reduced coinsurance starting April 1, 2023. CMS will select which Part B drugs to include. Refunds will be sent to members who qualify once CMS releases the drug lists to the plans each quarter. CMS has the right to review and change this list of drugs up to 4 times a year.