IRA: Q2 Impact for Reduced Coinsurance for Part B Rebatable Drugs

July 19, 2023

Section 11101 of the Inflation Reduction Act provides the requirement that beginning April 1, 2023, for MA Part B Plans, rebatable drug coinsurance must be capped to not exceed the beneficiary coinsurance as shown in the quarterly ASP pricing file. The Center for Medicaid & Medicare Services (CMS) released the first list of part B rebatable drugs on March 15, 2023 and a revised list on March 29, 2023.

Prime has completed our analysis of claims from April 1, 2023 – June 30, 2023. No claims for the NDCs associated with the 20 HCPCS outlined by CMS as being subject to reduced coinsurance were identified. The NDCs included in this review are provided here.

If you have questions, please reach out to your Health Plan Markets (formerly known as Client Engagement*) representative.

*There are no changes to the support clients receive from Prime team members. We have simply updated the Client Engagement business unit name to Health Plan Markets to capture more clearly the Prime + MRx structure.