Biden Administration Passes Medicare Prescription Drug Improvements

By Eileen Doherty, MS ~

Denver, Colo.  –  The Biden administration has reached a milestone to curb the cost of prescription drugs.  Only three of the provisions will go into effect in 2023, with the majority of the provisions going into effect in the next seven years. There are three cost-cutting provisions that will go into effect in 2023.

The most important benefit will limit the co-pays to $35 per month per prescription in Medicare Part D.  Under current rule, if you need more than one vial of insulin per month of the same type of insulin, you pay $35 for the first vial and full price for any additional vials.  If an individual has an insulin pump or similar medical device, the annual Medicare Part B deductible does not apply will not apply under the new provisions.  Additional insulin provisions will go into effect in 2026.

The second provision is the elimination of the co-sharing for adult vaccines covered under Medicare Part D that are recommended by the Advisory Committee on Immunization Practices. Covered vaccines include:  flu, pneumonia, shingles, T-Dap and chickenpox (if you did not have the vaccine as a child).  Medicaid will also cover the vaccine and administration costs of all approved adult vaccines.

The last provision is more complicated.  The drug manufacturer will be required to pay rebates to the Medicare Supplementary Medical Insurance Trust Fund (Part B and Part D) if drug prices rise faster than the rate of inflation. If a drug manufacturer raises the price of single source drugs (only one company makes the drug) and biologicals covered under Medicare Part B and all drugs covered under Medicare Part D except those where the average annual cost is less than $100, they will be required to pay a rebate to the Trust Fund.  If manufacturers do not pay the rebate, they face a 125% penalty of the amount of the original rebate amount.

The Colorado Gerontological Society will be covering these provisions in our Medicare Monday series that starts October 17 and our Wednesday Lunch and Learns that start October 19 with more details coming.  If you have questions, call 303-333-3482 and ask to talk with a counselor.

Eileen Doherty

Eileen Doherty, MS is the Executive Director of the Colorado Gerontological Society.  Her areas of expertise include management and administration of nonprofit organizations, education and training on issues related to older adults, advocacy and policy development on senior issues, and clinical practice in working with seniors and families to manage their lives in the later years. She has been the Director of the Society since 1982.  She teaches Nonprofit Management for Fort Hays State University.