How the Inflation Reduction Act of 2022 impacts Priority Health Medicare members

On August 16, 2022, President Biden signed into law the Inflation Reduction Act of 2022, with the intent of “lowering costs for families, creating good jobs for workers and growing the economy from the bottom up and the middle out,” according to a White House briefing. This law includes tax, climate and health provisions.

Within the broad health category, there are several provisions to lower prescription drug costs for people with Medicare—and two of these will directly and positively impact Medicare members and their coverage starting January 1, 2023.

Starting April 1, 2023:

  • You will pay up to 20% coinsurance on Part B drugs. There may be times you pay less than 20%, but there will never be a time you pay more. Every quarter we receive updated information from CMS, and we will adjust your coinsurance accordingly. If your current benefit is less than the Part B change, your benefit will stay the same.

Starting July 1, 2023:

  • You will pay no more than $35 for a one-month supply of Part B insulin regardless of whether your deductible has been met (if your plan has a deductible).

 

#1 - Vaccine coverage

“The bill eliminates cost-sharing under the Medicare prescription drug benefit for adult vaccines that are recommended by the Advisory Committee on Immunization Practices,” as noted in The Inflation Reduction Act summary.

What it means for Priority Health Medicare Advantage members: Our plans will cover most Part D vaccines at no cost to you, even if you haven’t paid your deductible (if your plan has a deductible).

Covered vaccines

#2 - Insulin coverage

“The bill caps cost-sharing under the Medicare prescription drug benefit for a month's supply of covered insulin products at (1) for 2023 through 2025, $35; and (2) beginning in 2026, $35, 25% of the government's negotiated price, or 25% of the plan's negotiated price, whichever is less,” as noted in .

What it means for Priority Health Medicare Advantage members: You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible (if your plan has a deductible).

The list of impacted insulins included in this bill has not yet been provided to Priority Health or other health plans. We will update this page as we receive additional guidance.

Learn more about the Inflation Reduction Act and how it impacts healthcare costs in Michigan here.

If you have questions about the Inflation Reduction Act and how it impacts your coverage, please contact Customer Service: 888.389.6648 (TTY users call 711), 8 a.m. to 8 p.m., seven days a week.

Learn more about drug coverage on a Priority Health Medicare Advantage plan

When you have a Priority Health Medicare Advantage plan, your drugs are covered in one of three ways: under Part A (hospitalization), Part B (medical) or Part D (prescription) coverage. Find out more information.

Additional resources:

This page was last updated December 7, 2022

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