OIG reports showed a spike in ustekinumab costs for patients in Medicare Part D. Experts said Inflation Reduction Act changes in Medicare drug coverage will soften the blow.
for autoimmune diseases much more expensive, a finding that experts say illustrates the need for reforms created by the Inflation Reduction Act of 2022 .Ustekinumab costs spiked as Medicare pushed patients to get their supply through the Part D pharmacy program. The aim of Part D is to make medicines more affordable and accessible for patients. It runs on a model of insurers to negotiate deals for pharmaceuticals.
"That should at least help with some of this price growth that over time has seemed quite egregious," Dusetzina toldThe IRA contains several provisions intended to curb rising drug costs for people enrolled in Medicare, including allowing the federal government to directly negotiate on some medicines.
"It may not be better for someone who was filling this on Part B, who had a supplement , but it will be better for a lot of people that it's covered under Part D," Dusetzina said."The good news is that at least from a beneficiary affordability standpoint, they're going to have some price protection."
In 2020, Medicare administrative contractors — the units or affiliates of insurers that for decades have processed Part B claims for the traditional Medicare programs — determined that subcutaneous ustekinumab did not meet the criteria for coverage under Part B. Implementation of this change was delayed due to the COVID public health emergency but has since taken effect.
Biologics Medicare Practice Management Revenue Psoriatic Arthritis Arthropathic Psoriasis Psoriatic Arthropathy Psa Crohn's Disease Crohn Disease Regional Enteritis Crohn Crohn’S Ulcerative Colitis Ulcerative Colitis (UC) UC - Ulcerative Colitis Inflammatory Bowel Disease IBD - Inflammatory Bowel Disease IBD Psoriasis Drug Costs Drug Cost Medication Costs
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