Presentation (CTI)

OBJECTIVES: There is little doubt that the Inflation Reduction Act (IRA) will influence payer behavior due to its far-reaching and multi-faceted nature, but no consensus on precisely how they will react, what contracting strategies they will deploy, or how their utilization management tactics will change going forward. We seek to capture changes in perceptions, payer management strategies, and reactions to the law over time by comparing the survey outcomes to the results presented at the 2024 ISPOR conference in Atlanta.
METHODS: A survey of 30 payers representing 35 million Medicare lives was conducted using Qualtrics. A majority of the questions were left unchanged in this year’s survey, and new questions on recent developments were added. The respondents were queried on various provisions of the IRA, such as CMS drug price negotiation, the Medicare Part D redesign, inflation rebate provision, and role of government subsidies.
RESULTS: Our research indicates that payers will continue to respond to the IRA by narrowing formularies in order to compensate for IRA provisions such as increased cost-sharing of Medicare Part D therapies, and the law’s limit on Medicare premium increases. Payers once again stated that manufacturers compensating for the IRA by reducing commercial rebates is one of their top concerns. Novel results include the findings that payers are likely to add new tiers in response to the IRA, with a particular emphasis on diabetes drugs and other TAs containing drugs selected for negotiation. In addition, the respondents believe the new Part D Premium Stabilization Demonstration will benefit stand-alone Prescription Drug Plans and make future withdrawals less likely.
CONCLUSIONS: Pharmaceutical companies should be prepared for significant shift in payer behavior in the years ahead. Increased clinical differentiation will be needed to ensure strong coverage of novel therapies, especially in TAs that have incumbents with low, negotiated prices.