7 key dates for health insurance in the new climate and health law


When President Biden signed HR 5376 today, he brought the Inflation Reduction Act of 2022 to life.

The new law fills 273 pages of PDF files. Many provisions relate to corporation tax, tax relief linked to alternative energies and health coverage for those under 65 years of age.

Other provisions could affect what Medicare customers pay for drugs.

For a quick summary, see the gallery above.

The text of the new law includes more than 450 dates, including about 100 dates describing and implementing Medicare-related periods.

What this means

An immediate effect for financial advisers will be to fight over whether the new law can move the acronym “IRA” away from individual pension plans.

Another effect will be to determine which parts of the new law will apply in the real world and which parts will be softened or completely ignored.

Watching how well federal agencies meet statutory implementation deadlines can give advisers clues about which Medicare provisions matter and which don’t.

7 Medicare dates you need to know

Here’s a look at seven health insurance dates in the new law that could affect advisers’ clients.

1. December 31, 2022: Medicare Part B Reimbursable Drug Price Tracker (Section 11102)

Drugmakers are supposed to pay rebates to the Medicare program if the prices of certain types of drugs provided through the Medicare Part B outpatient and medical services program rise faster than the rate of inflation.

This rule will apply to drugs supplied during the 12-month period that begins October 1, 2022, and the US Secretary of Health and Human Services is expected to provide instructions on how to implement the rebate program. early enough for the manufacturers to pay the due rebates. for drugs sold during that first 12-month “applicable period”.

This provision could hurt customers by helping to keep Medicare Part B premiums low, but it could cause drugmakers to try to raise the prices of drugs patients buy using Medicare drug coverage. Share D, ordinary commercial cover, their own money or other arrangements.

2. January 1, 2023: Medicare Part D drug plan cost sharing for adult recommended vaccines (Section 11401)

Effective January 1, 2023, Medicare Part D drug coverage is intended to cover adult recommended vaccines without imposing deductibles, co-payment requirements, or coinsurance requirements.

The early applicability date of this requirement means that Medicare program managers may already be drafting the regulations necessary to implement this provision.

3. January 1, 2023: Medicare Part D insulin co-payment rules (Section 11406(a))

Effective January 1, 2023, a stand-alone Medicare Part D drug plan or Medicare Advantage plan that provides pharmacy benefits must limit the patient’s co-payment for insulin to $35.

The limit will increase to the lesser of $35, 25% of a specified “maximum fair price” or 25% of a negotiated insulin price effective January 1, 2026.

4. February 1, 2024: Selected drug release date for Medicare’s Drug Price Negotiation Program (Section 11001)

The Secretary of Health and Human Services is expected to begin phasing in price negotiations for some high-priced single-source drugs in 2026.

For this to work, the HHS Secretary is supposed to pick “10 drugs eligible for negotiation” for 2026 and release their names on the selected drug release date.

5. March 1, 2024: Join a Medicare Part D drug manufacturer rebate program (section 1860D-14C)

The new law replaces the current coverage gap rebate program with a new rebate program, for Medicare Part D enrollees who have exhausted regular prescription drug benefits and have not yet reached the new coverage gap. drug expenses of $2,000 per year.

The new program will begin January 1, 2025. To participate in the first year, a manufacturer must enter into an agreement with the Secretary of Health and Human Services by March 1, 2024.

6. November 1, 2024: End of negotiation period for drugs selected for Medicare’s Drug Price Negotiation Program (Section 11001)

One sign that Medicare’s new price negotiation program for certain high-priced, single-source drugs is on track to influence prices in 2026 is if the Secretary of Health and Human Services completes price negotiations by November 1, 2024.

7. 2025: $2,000 Maximum Reimbursable Drug Cap for Medicare Part D Enrollees (Section 11201)

The $2,000 out-of-pocket expense limit will take effect in 2025. Medicare program managers will adjust the limit for inflation in future years.

(Image: Adobe Stock)


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