What is the Inflation Reduction Act and how will it impact Medicare?

Introduced in 2022, the Inflation Reduction Act (IRA) is a federal law that has made a number of improvements to the Medicare program. Among other things, the IRA has expanded Medicare benefits, helped reduce Medicare members’ out-of-pocket costs for prescription drugs, and expanded coverage for a number of recommended vaccinations.

Although several key changes have already gone into effect, additional changes that impact Medicare Part D, including drug pricing and benefit updates, are projected to begin in 2025. Learn more about the developments that have already been enacted and get the details on what can be expected in the coming year.

One of the most significant changes introduced by the Inflation Reduction Act was the update to insulin and vaccination coverage for Medicare Part D members. The goal of this change was to reduce costs associated with ongoing insulin use, and to expand accessibility to eligible Medicare members. 

As of January 1, 2023, the IRA capped member cost-sharing for Part D-covered insulin products at $35/month. This means that members can obtain insulin at $35/month per covered prescription (or less if their plan benefit has lower cost for insulin) regardless of benefit phase and without needing to meet their deductible.

• Injectable insulin that is not used with a traditional/reusable insulin pump
• Insulin used with a disposable pump 

It’s important to note that the Medicare Part D $35 monthly cost-sharing cap does not currently apply to insulin used in traditional insulin pumps or insulin patch pumps. However, as of July 1, 2023, if you use a traditional insulin pump that is covered under Medicare Part B as durable medical equipment (DME), your Part B-covered insulin is now subject to the $35/month cost-sharing cap.

As of January 1, 2023, Part D-covered adult vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) are now available to members at no cost. This means members with Medicare Part D coverage can get ACIP-recommended vaccines without paying any cost-sharing and without meeting their deductible.¹ Vaccines like the shingles vaccine, Tetanus-Diphtheria-Whooping Cough vaccines, and the influenza vaccine are just a few of the ACIP-recommended vaccines. For more information, the Centers for Disease Control and Prevention (CDC) website offers a complete list of vaccinations that are recommended by the Advisory Committee on Immunization Practices.

For additional information related to the IRA and how it may impact your current or future Medicare Part D coverage, you can visit cms.gov.

View answers to frequently asked questions related to the Inflation Reduction Act.