Impact of Inflation Reduction Act on prescription drug costs, access, and the financial impact of Medicare D reimbursement

The implementation of the Inflation Reduction Act in 2024 has a significant impact on both pharmacies and patients. Patients covered under Medicare Part D will see potentially significant savings from capped insulin costs to major reductions in total out-of-pocket spending. For patients receiving specialty medications, the IRA will be a huge relief from the financial toxicities that often face a patient and their access to affordable treatment. For pharmacies, it is a mixed bag of results. The reduction in out-of-pocket costs for patients can potentially allow patients to stay on therapy longer which can increase a pharmacy's revenue. This reduction can also help to steer patients to utilize a specialty pharmacy and benefit from their services, as opposed to obtaining meds from free manufacturer drug programs. With the IRA, Pharmacies were supposed to benefit from the elimination of retroactive DIR fees, with new, upfront, clarity of reimbursement at the point of service. Unfortunately, PBM contracted rates reduced significantly in January, and the fees they are incurring are not easy to deduce from the reimbursement. For specialty pharmacies, this reduced reimbursement is having a catastrophic financial impact on their ability to fill prescriptions for certain insurances, instead, having to send the prescription (and patient) out to a PBM-owned pharmacy. Navigating through this process is very challenging.