The Inflation Reduction Act
An early guide for patients with myeloma
By Danielle Doheny, IMF Director, Public Policy & Advocacy
You may have heard rumblings about upcoming changes to the Medicare program. The recently enacted Inflation Reduction Act (IRA) brings about significant changes to prescription drug coverage for Medicare beneficiaries, including those battling myeloma. Understanding these provisions is crucial for patients and their care partners to ensure they receive the best possible healthcare while managing their costs. In this edition of Myeloma Today, we will review the key points from the IRA and offer insights tailored to myeloma patients.
Limit on out-of-pocket costs
One of the most significant changes in the IRA is the newly created limit on out-of-pocket costs for prescription drugs. This provision ensures that the cost of medications for Medicare beneficiaries, including those with myeloma, will not exceed $2,000 in a calendar year. Patients will also be able to spread these out-of-pocket costs over the course of the year – via monthly payments – if they wish to. A key point here: patients must opt in to enable this. We are now learning more details about how this policy will work. The IMF has joined the cancer community in providing comments to the Biden Administration about the implementation of this part of the law to ensure it works for our community.
For patients with myeloma, this means that the financial burden of expensive treatments and medications will be limited, providing much-needed relief to both them and their families.
Medicare Part D coverage gap
The IRA also addresses the notorious “donut hole” in Medicare Part D prescription drug coverage. For myeloma patients who often rely on costly medications, this is a significant development. Starting in 2024, once you hit the initial coverage limit for the year (approximately $3000), you will now pay a smaller percentage of the drug’s cost until you reach catastrophic coverage. In the catastrophic phase, your out-of-pocket costs are $0.
This provision provides financial security for myeloma patients who depend on high-priced medications.
Access to biosimilar drugs
The IRA promotes the use of biosimilar drugs, which are similarto existing biologic drugs. For myeloma patients, this can lead to more accessible and cost-effective treatment options. Biosimilars have the potential to provide comparable results while being more affordable, reducing the financial strain on patients.
The legislation empowers Medicare to negotiate drug prices directly with pharmaceutical companies for a certain number of drugs each year. The IRA allows the government to set the price for 10 to 20 high-spend prescription drugs each year, beginning with 10 drugs in 2026.
Those in favor of this provision believe it could result in lower costs for medications, a benefit that will have a significant impact on myeloma patients who often require expensive specialty drugs. Those opposed to this part of the law fear that it could impact innovation and reduce future cures.
The first list of drugs for negotiation has already been released and does not include any drugs used to treat myeloma. That said, the IMF has worked to ensure that the patient voice is included in this negotiation process so that in the future, our patients will have a voice at the table.
Support for low-income beneficiaries
The IRA takes steps to provide subsidies to help low-income beneficiaries cover the costs of their Medicare premiums. This financial assistance can make a significant difference for myeloma patients in managing the costs associated with their treatment. These provisions aim to reduce the financial strain on individuals and families, ensuring that everyone, regardless of their financial situation, has access to quality healthcare.
The Bottom Line
The Inflation Reduction Act brings significant changes in prescription drug coverage for Medicare beneficiaries, including those diagnosed with myeloma. Understanding these provisions is crucial to navigating the complex landscape of healthcare costs and making more informed choices with coverage and benefits.
From capping out-of-pocket costs to closing the Part D coverage gap, these provisions are designed to alleviate the financial burden associated with treatment. For patients with myeloma, these changes may offer some important financial relief.
(This article was published in the 2023 Fall Edition of the IMF's quarterly publication, Myeloma Today. Read the full publication here.)
How does this affect me as someone living with myeloma?
- A Limit on Out-of-Pocket Costs: Starting in 2025, you will not pay more than $2,000 per year for your medications. You can spread these costs over months if you choose.
- Part D Coverage Gap Addressed: Starting in 2024, After reaching a spending limit of around $3,000, you'll pay a smaller portion of the drug cost until reaching a phase with $0 out-of-pocket expenses. This helps especially when relying on expensive medications.
- Access to More Affordable Drugs: A push for biosimilar drugs will offer cheaper options that work similarly to current drugs. This might cut costs for treatments, reducing financial strain.
- Negotiation on Drug Prices: The government can now negotiate prices for certain drugs each year. While some see this as a chance for lower drug costs, others worry about its impact on new treatments. The first list doesn’t include myeloma drugs, but efforts are underway to ensure patient voices are heard in these negotiations.
- Support for Low-Income Patients: The IRA includes financial help for low-income beneficiaries to cover Medicare premiums. This assistance can greatly help manage the costs linked to treatment, ensuring everyone, regardless of their finances, can access quality healthcare.