IRA Provision: The Medicare Prescription Drug Inflation Rebate Program

The Centers for Medicare & Medicaid Services (CMS) issued a fact sheet and a list of 27 Part B "rebatable drugs":

Abelcet Cytogam Leukinen Sylvant
Akynzeo Elzonris Minocin Tecartus
Atgam Fetroja Mircera Winrho
Aveed Flebogamma
Nipent Xiaflex
Folotyn Padcev Xipere
Fragmin Rybrevant Yescarta
Carnitor Humira Signifor

Key Considerations

  • The inflation-adjusted coinsurance percentage limitation—calculated in accordance with the Inflation Reduction Act—will apply to the 27 rebatable drugs from April 1 through June 30, 2023.
  • CMS will post an updated list of rebatable drugs and corresponding coinsurance adjustments each quarter as part of the Medicare Part B Quarterly Sales Pricing (ASP) file.

Next Steps for Stakeholders

  • Many Medicare and Medicare Advantage beneficiaries should see reduced coinsurance or refunds for these rebatable drugs purchased after April 1, 2023.
  • CMS’s determination of whether a drug is a Part B rebatable drug is considered final.
  • Manufacturer suggestions of calculation errors may be submitted within 10 days after receipt of a Preliminary Rebate Report.

Related Documents

Fact Sheet: Part B Rebatable Drug Coinsurance Reduction

Reduced Coinsurance for Certain Part B Rebatable Drugs (April 1 - June 30, 2023)

Date of Issuance: March 15, 2023

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