On August 16, President Biden signed the Inflation Reduction Act (H.R. 5376), the long-awaited tax, climate, and health-care bill, into law. The law includes provisions allowing the Department of Health and Human Services (HHS) Secretary the ability to negotiate prices for certain drugs under Medicare. The drugs will be chosen from a list of the drugs with the highest total expenditures under Part D for 2026 and 2027, and Part D and Part B beginning in 2028 and subsequent years – many of these are likely to be cancer treatments. Ten drugs will be selected in 2026, increasing to 20 drugs by 2029. The legislation also calls for manufacturers of Part B and D drugs to pay rebates if their prices increase above a threshold, and would cap Part D patient out-of-pocket costs at $2,000, with the option to break that amount into affordable monthly payments.
Also included in the Inflation Reduction Act was a provision extending for three years (through 2025) enhanced subsidies for people buying their own health coverage on the Affordable Care Act Marketplaces. The enhanced subsidies increase the amount of financial help available to those already eligible and also allow middle-income people, many of whom were previously priced out of coverage, to access subsidies. Extension of the enhanced subsidies means that premium payments in 2023 will hold mostly flat for Marketplace enrollees, since the premium tax credits shelter enrollees from increases in the underlying premium.
The provisions included in the new law are significant wins for patients with hematologic and oncologic diseases and disorders, allowing better access to care for those previously priced out of coverage and lowering overall out-of-pocket costs.
Click here for more information on HR 5376.