The Inflation Reduction Act/IRA continues to be a hot topic, so let’s get down to it…
As a result of President Biden’s signing of this Act, many significant changes to the Medicare B and Part D programs must be implemented. They will not all be implemented immediately, rather in stages.
The first changes that will take effect 1/1/2023 include:
- Limiting the member cost-share of covered insulins to $35 (see attached spreadsheet for a list of insulins Aetna is covering at $35 or less)
- Introducing $0 member cost-sharing on Part D vaccines
Here’s a little more info about the member cost-share on covered insulins (also see attached)…
- Members won’t pay more than $35 for a one-month supply of each insulin product covered by their plan, no matter what cost-sharing tier it’s on, even if their plan has a deductible that hasn’t been met.
- While some members already benefit from plans that offer $35 insulin, this legislation ensures that all seniors who use insulin benefit from this out-of-pocket cost limit.
- Members receiving LIS will continue to pay the CMS statutory maximum cost share for insulin, which is less than $35.
- In addition, the 2023 SmartSaver PDP (which is non-commissionable for new sales), available in all 50 states, offers covered insulin for a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies.
And here’s some info about $0 cost-share for Part D vaccinations…
- Our 2023 plans will cover most Part D vaccines for a $0 cost share, even if a plan has a deductible that hasn’t been met…YES, this includes SHINGRIX!!!