CMS Shortens List of Price-Capped Part B Drugs
CMS removed seven drugs from its first list of Part B drugs whose prices rose faster than inflation, shortening the list of price-capped drugs from 27 to 20.
As a reminder, the IRA instituted a penalty for drug manufactures that raises the price of a Part D drug faster than inflation. The first rebate period began October 1, 2022, in Part D and January 1, 2023, in Part B. The law uses 2021 as the base year for determining price changes relative to inflation. In 2025, CMS intends to send the first invoices to drug companies for the 2023 and 2024 rebates.
In the agency’s quarterly ASP report, a total of 27 Part B drugs were listed for having list prices that rose faster than inflation. The biggest name on the list was Humira, an immunosuppressive drug that is most commonly used to treat rheumatoid arthritis, but is also used to treat Crohn’s disease, uveitis and ulcerative colitis. Medicare beneficiaries may see lower out-of-pocket costs for the specific Part B drugs listed in the ASP report. For these drugs and biologicals, the beneficiary coinsurance will be 20 percent of the inflation-adjusted payment amount, which will be less than what the beneficiary would pay in coinsurance otherwise. Lower Part B coinsurance will go into effect on April 1 and will be reviewed quarterly. By reducing coinsurance for some people with Part B coverage and discouraging drug companies from increasing prices faster than inflation, CMS hopes that the Medicare Prescription Drug Inflation Rebate Program may lower out-of-pocket costs for some people with Medicare and reduce Medicare program spending overall.
However, without a formal announcement, CMS last week removed seven drugs from the list: Gilead’s Yescarta and Tecartus, Bausch + Lomb’s Xipere, Acrotech Biopharma’s Folotyn, Shionogi’s Fetroja, Kamada’s WinRho and Stemline Therapeutics’ Elzonris.
“CMS issued a restatement correcting the calculation of the coinsurance adjustment percentage for Part B rebatable drugs,” CMS stated after healthcare publications reached out to the agency. “We have updated the files and supplemental materials to reflect the accurate calculations and updated the list of now 20 drugs for which reduced coinsurance applies.”
The agency initially claimed that seniors could see their out-of-pocket costs for these drugs decrease by $2 to as high as $390 per average dose. With seven of the drugs removed from the list, CMS has amended this estimate to be anywhere from $1 to $372 per average dose. CMS plans to send invoices for the remaining 20 listed products to drug manufacturers “no later than fall 2025.”
Source: National Association of Benefit and Insurance Professionals (NABP)