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Impact of the Inflation Reduction Act on Payer Drug Coverage and Utilization Management
Insights from a Quantitative Survey- Supplemental Content
Download now to understand these key changes:
- Enrollees will no longer face unlimited liability in Part D due to the patient cost cap. (2024 is a transition year, and features a patient cost cap of ~$3,500)
- Plans face 60% liability in the catastrophic phase, up from 15%
- Manufacturers see reduced discounts on lower-cost drugs due to elimination of “donut hole,” but pay new 20% discount in catastrophic phase
- Federal government has reduced Medicare cost-sharing for high-cost drugs in the catastrophic phase (20% vs. previous 80%)
- Not depicted: 6% cap on Medicare premium increases, co-pay smoothing program allowing seniors to spread their out-pocket costs out over time in monthly installments.
