Session (CTI)

ISSUE: Benefits, limitations, and implementation challenges of the pharmaceutical provisions of the Inflation Reduction Act implemented in 2025. OVERVIEW: The Inflation Reduction Act introduced important reforms to the Medicare Part D benefit beyond the well-known negotiation of drug prices. These include 1) the redesign of the Part D benefit, including a $2,000 out-of-pocket cap; 2) the ability to “smooth out” beneficiary payments throughout the calendar year; 3) the introduction of a $35 copayment cap for insulin products. While these reforms were well-intended to improve drug access, some may have unintended consequences or face implementation challenges. For instance, Part D redesign may result in the replacement of fixed copayments with co-insurance (%) for branded drugs. Medicare Part D beneficiaries may not be aware of the ability to smooth out-of-pocket payments during the year, which will preclude their enrollment. Finally, copayment caps may not make a difference for the large share of beneficiaries already paying amounts below the proposed caps. The panelists will present timely data on the impact of these provisions, supporting a balanced debate of the limitations and benefits of these reforms. Dr. Anderson (10-12 min) will discuss the implementation of insulin copayment caps and their impact on beneficiary out-of-pocket spending. Dr. Patterson (10-12 min) report changes in formulary design in 2025 by the leading Part D sponsors. Dr. Sepassi (10-12 min) will present projections for Medicare Part D beneficiaries benefiting from the $2000 out-of-pocket cap and the ability to smooth payments throughout the year. Dr. Hernandez will provide remarks on the interactions of these provisions (6-8min) and open the floor for questions (20 min). The moderator will seek inclusion of the panel on the Women in HEOR ISPOR list of events, as it features the novel and impactful research of women in the field.