Q&A: Understanding Future Impacts of the IRA
Data from 2024 are being used as a way to predict what changes may be on the way for 2025.
Corey Ford, Vice President of Reimbursement and Policy Insights at Cencora, sat down with Drug Topics at AXS24, the Asembia Specialty Pharmacy Summit, to discuss the evolution of the Inflation Reduction Act and what stakeholders—from biopharma companies to payers—can expect in 2025 and beyond.
Stakeholders require clarity around some provisions of the Inflation Reduction Act. | image credit: EtiAmmos - stock.adobe.com
Drug Topics: What are some of the key regulatory changes that have been made in the wake of the Inflation Reduction Act?
Corey Ford: There's been a lack of clarity on the Medicare drug price negotiation program. They've provided a lot of clarity on the data submission that a selected manufacturer has to provide, and what the patient engagement sessions will look like, and things like that. But there's really a lack of clarity right now and how to operationalize the manufacturer fair price. That’s something that CMS is going to have to grapple with here in the coming months.
On the Part D benefit redesign, they've certainly provided a lot of information, particularly related to not just the out of pocket cap, but what is known as the Medicare Prescription payment plan that helps smooth patient out of pocket costs throughout the year.
How have payers responded to the Medicare Part D benefit redesign, and how has this response impacted patients (either positively or negatively)?
It's a great question. I think we have some data in 2024 that is really showing to be a harbinger for what we could see next year. We did a survey at Xcenda within our managed care network of payer contacts looking at 2025. The way payers were thinking about reacting were, narrow drug coverage outside of the protected classes, higher [utilization management], and lessPart D plan availability. Those were some of the bigger challenges.
[This year] 2024 gives us real data. What we seen is around a 12% reduction in the total number of standalone prescription drug plans. We've seen higher utilization management and even higher premiums, and that is something that I think is going to tell us what 2025 could look like as well.
AXS24, the Asembia Specialty Pharmacy Summit, was held April 28 to May 2 in Las Vegas, Nevada. Click here for more of our coverage from AXS24.
