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

The Inflation Reduction Act of 2022 (IRA) is a new federal law that makes improvements to the Medicare program. Among other things, the IRA will expand Medicare benefits and help reduce Medicare members’ out-of-pocket costs for prescription drugs.

Insulin and vaccine coverage changed for Medicare Part D 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 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),¹ your Part B-covered insulin will be 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 The shingles vaccine, Tetanus-Diphtheria-Whooping Cough vaccines and the influenza vaccine are just a few of the ACIP-recommended vaccines included. 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.