Part D-2025 What's behind the scenes? This is the best explanation that I've seen so far.

[Duaine]

Surprise! Thanks to the IRA, Part D Plans Will Prefer High-List, High-Rebate Drugs

Like many of you, I have believed that the Inflation Reduction Act of 2022 (IRA) will encourage Medicare Part D plans to adopt low-list-price products over their high-list/high-rebate counterparts, thereby popping the gross-to-net bubble.

Actually, maybe not.

Below, I explain why the IRA will encourage Part D plans to prefer high-list, high-rebate specialty drugs, even as the government and manufacturers will prefer a low-list-price version. Just another IRA-inflicted hit for biosimilars?

The warped incentives don't stop there. Even more weirdly, both products with a negotiated maximum fair price (MFP) and low-list-price products will raise total costs for the healthcare system and increase beneficiary premiums.

Did I get this latest unintended consequence right? Or have I been spending too much time underwater in Bikini Bottom? Read on and see what you think.

[EXTERNAL LINK] - Surprise! Thanks to the IRA, Part D Plans Will Prefer High-List, High-Rebate Drugs