Most payers believe implementation of the Inflation Control Act (IRA) will have a financial impact on Medicare Part D plans, according to a poster presented at AMCP Nexus 2023.
Researchers found that IRAs contain multiple policy provisions related to Medicare Part D benefit design and drug pricing, such as caps on beneficiary out-of-pocket costs, which shift costs from the government and beneficiaries to manufacturers. and manufacturers, which would impact U.S. health care payers. Part D Planning. They need insight into how U.S. payers plan to respond to these Part D policies to predict how the introduction of IRAs will impact patient access and affordability. explained that it is necessary.
As a result, researchers evaluated payer perceptions of IRAs and their potential impact on Medicare Part D plans.
The double-blind, web-based survey was distributed to U.S. health insurance payers between February 23, 2023 and March 7, 2023 using Cencora’s managed care network. These are care executives, medical directors, pharmacy directors, and other people with extensive managed care experience who represent more than 310 million insured lives in the United States. ”
The survey received 50 responses, with 66% of respondents being pharmacy managers, 32% medical directors, and 2% contract managers or directors.
Medicare Part D
Image credit: Driftwood – Stock. adobe.com
The survey found that 44% (n = 22) expect an IRA to have a negative financial impact on their Part D plan, and 34% (n = 17) expect a relatively limited financial impact. got it. Meanwhile, 10% (n = 5) of payers surveyed believe the change will have a positive financial impact, while 18% (n = 9) are unsure about the impact. Additionally, 20% (n = 10) believe that the policy change will reduce the number of Part D plans their respective organizations offer, while 8% (n = 4) believe that the policy change will reduce the number of Part D plans they offer. We believe that the number of plans will increase.
The researchers also found that payers expect their formularies to be narrower due to the IRA Part D changes, with most payers expecting formulary widths to be slightly narrower (52%) compared to the current design. ) or significantly (24%) indicated that they expected it to be narrower. Conversely, 20% expect a relatively similar prescription range.
On the other hand, most payers expect greater utilization control due to the increased financial responsibility of Part D plans. Specifically, 42% (n = 21) expect better overall usage management and 32% (n = 16) expect better usage management for high-cost drugs. Additionally, 16% (n = 8) expect change on a case-by-case basis and 10% (n = 5) expect no change.
Finally, the researchers found that most payers believe that IRAs increase Part D plan premiums, with 8% (n = 4) expecting premium increases of 10% or more; We found that 40% (n = 20) expected an increase. from 5% to 10%, and 18% (n = 9) expect an increase of up to 5%. Few payers expect Part D plan premiums to remain at current levels (12%, n = 6) and few payers expect premiums to be reduced below current levels. He pointed out that there are no payers who do so.
The researchers also acknowledged the study’s limitations. One was that the survey responses were from a small sample size and therefore reflected a selected perspective. Due to the small sample size, the results may not be generalizable to all payer organizations. Similarly, the sample consisted only of people within his Cencora managed care network and therefore was not representative of the perspectives of stakeholders outside the network.
Despite these limitations, researchers found that while the study clearly showed that U.S. payers expect IRAs to have a financial impact on Part D plans, the exact impact is He pointed out that further research is needed to better understand.
“Most payers anticipate increased Part D premiums and greater use of utilization management strategies to contain costs, both of which could negatively impact patient access and affordability. ” write the authors. “Additional analyzes are needed to examine the extent to which these changes impact patient access to care and how these perspectives change over time.”
reference
Ford C, Westrich K, Buelt L, Loo V. Payer reactions to implementation of the Inflation Control Act: Predicting future changes to Medicare Part D plans. Presentation location: AMCP Nexus 2023; October 16th to October 19th, 2023. Orlando.
