Loi sur la réduction de l'inflation et Medicare :ce que vous devez savoir

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Major changes to prescription drug affordability for more than 50 million beneficiaries enrolled in Medicare Part D are on the way because of a new law.

The Inflation Reduction Act "finally delivers on a promise that Washington has made for decades to the American people … We’re giving Medicare the power to negotiate for lower prescription drug prices,” President Joe Biden said in a July speech announcing a deal in Congress to pass the legislation.

Les négociations sur les prix ne sont pas la seule disposition de la loi ciblant les coûts des médicaments sur ordonnance Medicare. There are also new caps on out-of-pocket spending, limits on increases in premiums and drug prices, and more.

Biden a signé la loi en août 2022. Certains changements entreront en vigueur en 2023, tandis que d'autres ne commenceront qu'en 2026.

Voici ce que les parties Medicare de la loi sur la réduction de l'inflation signifieront pour vous.

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Medicare négociera les prix des médicaments

Medicare will start to negotiate prices for qualifying prescription drugs on which it has spent the most money:10 drugs in 2026, 15 total in 2027, 15 total in 2028 and 20 total each year from 2029 on.

“The Inflation Reduction Act targets the most expensive, most used drugs that have enjoyed limited competition and maximum profit,” Sen. Kirsten Gillibrand, a Democrat from New York and member of the Senate Special Committee on Aging, said in an email.

Auparavant, la loi interdisait à Medicare de négocier les prix des médicaments sur ordonnance.

What it means for you:If you are prescribed one of the drugs with negotiated prices, you should see reduced prices starting in 2026. How much you could save depends on which drugs you take and the results of the negotiations.

Negotiated drugs will be covered by all plans

Auparavant, Medicare n'était pas autorisé à définir ces exigences en matière de formulaire.

What it means for you:If you take a drug with a negotiated price, your Medicare Part D plan has to cover that drug.

Les dépenses personnelles seront plafonnées à 2 000 $

À partir de 2025, les dépenses personnelles pour les médicaments sur ordonnance Medicare Part D seront plafonnées à 2 000 $.

Ce plafond augmente les années suivantes en fonction des dépenses annuelles de Medicare pour les médicaments couverts. If Medicare spends 5% more, for example, the cap for 2026 would be 5% higher:$2,100.

Previously, there was no out-of-pocket spending cap for Medicare Part D.

What it means for you:After you hit the $2,000 out-of-pocket cap in 2025, you won’t owe any more copays or coinsurance for covered drugs for the rest of the year (you’ll still have to pay your premiums). After 2025, the cap will be higher but still based on that $2,000 starting point.

Catastrophic coverage will no longer require coinsurance

À partir de 2024, les bénéficiaires ne paieront rien de leur poche pendant la phase catastrophique de la couverture Medicare Part D. (In 2022, that means after your qualifying spending reaches $7,050.)

Previously, beneficiaries paid a 5% coinsurance during this phase, with a minimum of $3.95 for generic drugs or $9.85 for brand-name drugs in 2022.

What it means for you:If you reach the catastrophic out-of-pocket spending threshold after the start of 2024, you’re done with out-of-pocket costs for Medicare Part D for the year. Étant donné que le plafond de 2 000 $ à payer entre en vigueur en 2025, cette disposition n'est réellement pertinente qu'en 2024.

Drug price increases can’t exceed the rate of inflation

Starting in 2023, drug manufacturers will have to send rebates to Medicare if their prices for most prescription drugs covered by Medicare go up faster than the rate of inflation.

Ce que cela signifie pour vous :Les prix de vos médicaments d’ordonnance couverts pourraient augmenter plus lentement. According to a February 2022 analysis by the Kaiser Family Foundation, about half of all drugs covered by Medicare had price increases greater than the rate of inflation from 2019 to 2020. Under the new law, those increases would be effectively capped at the rate of inflation.

Les augmentations des primes Medicare Part D seront limitées

Starting in 2024, the national base beneficiary premium for Medicare Part D plans can’t increase by more than 6% per year.

Ce que cela signifie pour vous :Vos primes annuelles Medicare Part D pourraient ne pas augmenter aussi rapidement qu’elles le feraient autrement. However, the national base beneficiary premium is just one component of what you actually pay. Vos primes varieront également en fonction du lieu, de la compagnie d'assurance et du régime.

Out-of-pocket costs for insulin will be capped

Starting in 2023, monthly out-of-pocket costs for covered insulin products will be capped at $35. Les franchises ne s'appliqueront pas aux produits à base d'insuline.

What it means for you:Your plan won’t be able to require more than $35 per month in coinsurance or copays for covered insulin products, even if you haven’t yet met your Medicare Part D deductible.

Starting in 2024, individuals with income up to 150% of the federal poverty level, or FPL, will be eligible for the full Medicare Part D low-income subsidy, also known as Medicare Extra Help.

Previously, the full subsidy was available at 135% of the FPL, and partial subsidies were available on a sliding scale between 136% and 149% of the FPL.

What it means for you:If your income is below 150% of the FPL (in 2022, that’s $20,385 for a single person in the contiguous 48 states) and your resources are below the required thresholds, you may qualify for the full Extra Help subsidy to help pay for your Medicare Part D costs.

Les vaccins pour adultes n'auront aucune exigence de partage des coûts

Starting in 2023, there will be no deductible, coinsurance or other cost-sharing requirements for adult vaccines covered under Medicare Part D.

What it means for you:You can get any vaccine covered by Medicare Part D without any out-of-pocket costs.