The Inflation Reduction Act and Medicare: Every Drug Pricing Change Explained
Watch on YouTube The Inflation Reduction Act of 2022 is the most significant Medicare drug pricing reform since Part D was created in 2003. This episode covers all five major provisions: drug price negotiation for ten drugs with 38-79% price cuts, the $2,100 annual out-of-pocket cap, the $35/month insulin cap, zero-dollar vaccines, and inflation rebates. Watch the next video in this playlist for the practical guide to formularies, tier exceptions, and the Prescription Payment Plan. Verify details at Medicare.gov or contact your State Health Insurance Assistance Program at shiphelp.org.
▶ Watch next: Medicare Part D in Practice: Formularies, Exceptions, and the Prescription Payment Plan https://www.youtube.com/watch?v=HcQ_VaTuYwo
📺 Full playlist: Medicare (US - 2026) https://www.youtube.com/playlist?list=PLlIAFxS29648I08akd—o7PeoOBzdOb2S
Chapters
The Inflation Reduction Act of twenty twenty-two is the most significant Medicare drug pricing reform in the program's history. It gave CMS the power to negotiate drug prices for the first time, capped out-of-pocket costs, capped insulin, eliminated the donut hole, penalized drug companies for raising prices faster than inflation, and created the Medicare Prescription Payment Plan. This episode is a comprehensive walkthrough of every IRA provision affecting Medicare beneficiaries, with real dollar amounts.
Key Topics
- Drug price negotiation: CMS negotiates maximum fair prices for high-cost drugs — ten drugs in twenty twenty-six, fifteen more in twenty twenty-seven, fifteen more in twenty twenty-eight, twenty more each subsequent year
- The ten drugs with negotiated prices in twenty twenty-six: Eliquis (blood thinner), Jardiance (diabetes), Xarelto (blood thinner), Januvia (diabetes), Farxiga (diabetes/heart failure), Entresto (heart failure), Enbrel (autoimmune), Imbruvica (cancer), Stelara (autoimmune), and insulin products
- The two thousand one hundred dollar annual out-of-pocket cap: replaces the old catastrophic coverage structure where patients still owed five percent of drug costs indefinitely
- The Medicare Prescription Payment Plan: lets beneficiaries spread their out-of-pocket drug costs into equal monthly payments throughout the year instead of paying large sums at the pharmacy counter
- Insulin cap: thirty-five dollars per month for all Part D-covered insulin products — applies to all plans, all insulin types
- Inflation rebates: drug companies that raise Part D drug prices faster than inflation must pay rebates back to Medicare — this reduces both CMS costs and some beneficiary cost-sharing
- Vaccine coverage: all Part D vaccines are now covered at zero cost to the beneficiary (previously only some were free)