Pharmacist Education Is Necessary for Patient Understanding of Inflation Reduction Act

Patients must be educated on the Inflation Reduction Act, and pharmacists should be up to date with the latest information to assist patients, according to a panel session, The Inflation Reduction Act (IRA) Impact on Patient Financial Assistance: A Multi-Stakeholder Perspective, at the AXS23 Conference in Las Vegas, Nevada.

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The panelists included: Chuck Collins, president of Healthcare Stakeholder Solutions; Alan Klein, chief development officer at the HealthWell foundation; James Smith, pharmacy manager at Amber Specialty Pharmacy; Melissa Paige, vice president at the National Association of Medication Access & Patient Advocacy; and Krista Zodet, CEO and president of HealthWell Foundation.

The inflation reduction act was signed into law on August 16, 2022, and directs federal spending toward funding the internal revenue service, improving taxpayer compliance, lowering health care needs, and reducing carbon emissions.

“When we think about how beneficiaries are going to be impacted, we want to first think about how much we’re looking at research,” Smith said during the presentation. “About 15% to 20% of cases are actually reaching the catastrophic phase now.”

In 2023, the initial deductible phase was approximately $505, with patients paying 100%. During the initial coverage phase, patients paid 25% of the retail drug cost before meeting the $4660 coverage limit.

During the presentation, Collins also discussed the coverage gap phase, known as the “donut hole,” where patients paid 25% of the retail cost before meeting the $7400 coverage gap limit and then entered the catastrophic phase.

In 2023, the catastrophic phase, which was coverage over $7400 out of pocket, had patients paying approximately 5% of the retail.

In 2024, the catastrophic phase will be eliminated.

In 2024, $545 will be the initial deductible, with patients paying 100% of retail. The number was increased to $555 in 2025.

For the initial coverage phase in 2024, patients will pay 25% of the retail drug cost before meeting the $5030 limit. In 2025, patients will play 25% of the retail drug price up to $2000 out of pocket.

The donut hole will take place, with the patient playing 25% before meeting the $8000 out-of-pocket threshold in 2024, with the donut hole being eliminated in 2025.

Because of the nature of biosimilar drugs, patients will hit the threshold sooner, Smith said.

The Medicare Part D has 4 key stakeholders: the federal government, the health plan, manufacturers, and Medicare beneficiaries, \, Collins said.

The Inflation Reduction Act reduced payments by the government, which initially paid 80% in the catastrophic phase, to just 20%, with the manufacturer paying 20% and the plan paying 60%. he said.

“From a specialty pharmacy standpoint, this means more patients should have access to medication,” Smith said. “It’s really going to be based on education….We need to understand what the IRA is doing, so we can actually facilitate that information to our patients.”

Reference

Collins C, Klein A, Smith J, Paige M, Zodet K. The Inflation Reduction Act impact on patient financial assistance: a multi-stakeholder perspective. Presented at: AXS23 Conference. Las Vegas, NV. May 1, 2023.