Provider Resources

US Inflation Reduction Act (IRA): 2023 Medicare Prescription Drug Changes

Drug Cost Inflation Increase Limits

Beneficiaries pay less for some drugs covered under Medicare Part B and nearly all Part D covered drugs, if the drug cost increases faster than the US inflation rate (Part B 20% coinsurance is based on the lower-adjusted price)

Insulin Products

Beneficiaries may not pay more than $35 for a 30-day supply of Part D insulin products even if they have not met their deductible(s) or have entered the Part D Coverage Gap. Effective July 1, 2023, insulin covered by Part B (applicable when administered using an insulin pump) also may not cost more than $35 for a 30-day supply

• ATRIO Health Plan members pay $0 copay for covered Part D insulin until the coverage gap, during which they will pay $35 for a 30-day supply (see "Formulary Insulins” table)
• ATRIO Health Plan members pay 20% coinsurance for Part B insulin up to $35 for a 30-day supply

NOTE : Between January 1st and January 18th, 2023, ATRIO members may have been charged more than $35 for Part D insulin if they were in the Coverage Gap or if they received a non-formulary insulin product (e.g., Lantus) during a transition fill(s)

• What should members do?
  • Members can call ATRIO Customer Service at 1-877-672-8620 (TTY: 711) and request reimbursement
• What can prescribers do?
  • Switch your ATRIO members to a formulary insulin, if clinically appropriate

Vaccines

Beneficiaries must not have cost-sharing for all vaccines recommended for adults by the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), such as the shingles vaccine; this change brings Part D vaccine coverage more in line with Part B for other approved vaccines (including the flu and COVID-19)

NOTE : Following the end of the US Public Health Emergency (PHE) on May 11, 2023, cost-sharing may begin to apply for approved Part B COVID treatments