Inflation Reduction Act

Recent and Upcoming Changes

During 2024, several significant provisions of the Inflation Reduction Act of 2022 (“IRA”) became effective, and more will go into effect in 2025 and beyond. These include limits on patients’ out-of-pocket costs for prescription drugs covered under Medicare Part D and the publication of the negotiated prices for the first 10 drugs subject to the IRA’s price negotiation provisions. In 2028, reimbursement changes and prices for drugs covered under Medicare Part B that are selected for price negotiation will go into effect.

ACCC is monitoring the implementation of the law, including any direct and indirect impacts on patients and providers. It has expressed concern about changes to provider reimbursement for any Medicare Part B-covered drugs selected for negotiation and supports a legislative change to address this, as detailed below.

• Medicare Drug Price Negotiation Program
  • Negotiated prices will go into effect in 2026 for the 10 Part D drugs for which prices have been negotiated. The number of Part D drugs subject to negotiation will gradually expand in subsequent years.
  • Under the IRA’s new provisions, negotiation of prices for drugs covered under Medicare Part B could result in lower provider payments for certain physician-administered therapies, including oncology therapies, beginning in 2028. This could negatively impact cancer care practices and their ability to serve patients.
• Medicare Part D Benefit Redesign With a Cap on Beneficiary Out-of-Pocket Costs
  • The reformed Medicare Part D pharmacy benefit (“Part D redesign”)—which covers most retail prescription drugs—will have an out-of-pocket cap of $2,000 per year beginning in 2025.
  • The act also allows patients to choose to spread the $2,000 out-of-pocket amount across the entire year, thereby smoothing the costs they face. The successful implementation of this aspect of the law will require beneficiary awareness and strong communication between regulators and interested parties as it unfolds, to address any challenges that may arise.

Proposed Federal Legislation

ACCC has endorsed the Protecting Patient Access to Cancer and Complex Therapies Act (S.2764/H.R.5391). This proposed legislation seeks to mitigate the impact of any reduced Medicare reimbursement under Medicare Part B on the providers and health care practices that administer such therapies—including practices serving patients with cancer. It thereby also aims to alleviate any potentially negative consequences on patient access to care.

This bill seeks to ensure that providers administering Medicare Part B therapies are “made whole” if there are any changes in reimbursement for certain therapies covered by Medicare Part B (which could begin in 2028). Therefore, this legislation seeks to help ensure that multidisciplinary provider care teams are able to continue to administer these often complex therapies and provide the high levels of care associated with them.

Looking Forward

It is important that policymakers implementing the IRA and the patients and organizations impacted by its implementation consider the important role innovative therapies play in lengthening and saving patients’ lives. ACCC will continue to monitor any direct and/or indirect consequences of the IRA on patient access, providers, and the health care ecosystem and participate in related policy discussions on behalf of its members and the patients they serve.