Another round of Medicare Part B drugs capped by inflation rebates

A third set of Medicare Part B prescription drugs will cost up to $618 less per average dose beginning Oct. 1, announced the Centers for Medicare & Medicaid Services (CMS).

The policy, which applies to 34 drugs until Dec. 31, is possible through the Medicare Prescription Drug Inflation Rebate Program in the Inflation Reduction Act (IRA). It works through reducing coinsurance for beneficiaries with Part B coverage and discouraging drug companies from increasing prices faster than inflation, according to a release.

“CMS, through the prescription drug law, continues to lower out-of-pocket drug costs for some people with Medicare by protecting them from sudden out-of-pocket cost increases when drug companies raise prices faster than the rate of inflation,” said Meena Seshamani M.D., Ph.D., deputy administrator and director of the Center for Medicare, in a statement.

The full list of prescription drugs and biological products is available here (PDF). Many of the drugs on the latest list have been subject due to the IRA policy after being on previous iterations of the list earlier this year. It includes rheumatoid arthritis drug Humira, lung cancer drug Rybrevant and fungal infection drug Cresemba.

President Joe Biden’s rebate policy applies to single source drugs and biological products. The beneficiary coinsurance will be 20% of the inflation-adjusted payment amount for drugs that have risen in price faster than the rate of inflation, and the federal government invoices drug manufacturers no later than fall 2025 into the Medicare Trust Fund.

The Department of Health and Human Services (HHS) unveiled a 43-drug list in June for a rebate up to $449 per average dose. This occurred several months after HHS publicized its first Part B prescription drug list that included first 27, and then 20, drugs on the list.

CMS said Thursday it released quarterly average selling price files several weeks before the end of the quarter to give the agency leeway in case discrepancies or errors are found, necessitating the list of drugs to change.

Medicare Part D drug prices have increased by an average of 226% since market entry, a report from AARP's Public Policy Institute found in August. Those 25 drugs are responsible for $80.9 billion in total Part D spending in 2021.