While Medicare’s new right to negotiate prices on a handful of drugs has gotten the most attention, older Coloradans will start seeing lower costs from related changes in the Inflation Reduction Act far sooner.
, but it’s set at $100 per month and only applies to people in state-regulated commercial insurance plans.)Medicare splits how it covers vaccines, with some falling under the Part D drug program and others under Part B, which covers most medical costs other than hospitals and prescription drugs. Part B already covers vaccines without out-of-pocket costs, meaning it’s free for recipients to get a shot for flu, COVID-19, hepatitis B and some other conditions.
Part D plans can charge out-of-pocket costs for vaccines, though, and how much they charge varies. The most prominent vaccine under Part D is the shingles shot. Under the new law, all vaccines recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices will be free for Medicare beneficiaries.It will if you’re covered by Medicare and your Part D plan didn’t already offer vaccines for free.
If it has, the drug maker has to pay a rebate to Medicare, which is basically the difference between the actual average price, and what the average price would have been if it only rose as much as the inflation rate. There are exceptions for drugs with a current shortage and for those that cost less than $100 per person, per year.
Say HHS determines the average price is $1,000 higher than it should be, based on inflation. Then the drug maker has to pay $1,000 for every course of the drug covered by Medicare. It can keep the difference in sales to commercial plans, though.Not directly, because the rebate goes to Medicare, not to the people taking the medications. Since the average price includes both the prices charged to Medicare and commercial insurers, however, it could put pressure on drug makers to limit increases.
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