How Payers Expect IRA to Financially Impact Medicare Part D Plans

Most payers believe the implementation of the Inflation Reduction Act (IRA) will have a financial impact on Medicare Part D plans, according to a poster presented at AMCP Nexus 2023.

The researchers noted that the IRA includes several policy provisions related to Medicare Part D benefit design and drug pricing, including capping beneficiaries’ out-of-pocket spending, which will affect U.S. health care payers by shifting government and beneficiary costs to manufacturers and Part D plans. They explained that understanding how U.S. payers plan to respond to these Part D policies is necessary to predict how IRAs will be implemented could affect patient access and affordability.

Therefore, researchers evaluated payers’ perceptions of IRA and its potential impact on Medicare Part D plans.

A double-blind online survey was distributed to U.S. healthcare payers between February 23, 2023 and March 7, 2023, using the Cencoras Managed Care Network, a proprietary research panel comprised of more than 160 decision-makers from the health care sector, including health care managers. executives, medical and pharmacy directors and other experienced individuals in managed care, representing more than 310 million covered lives in the United States.

Their survey received 50 responses, of which 66% were pharmacy directors, 32% medical directors and 2% contract managers or directors.

From the survey, they found that 44% (n=22) predicted the IRA would have a negative financial impact on Part D plans and 34% (n=17) expected a financial impact relatively limited. In contrast, 10% of payers surveyed (n=5) believe the changes will result in a positive financial impact, while 18% (n=9) are unsure of its impact. Additionally, 20% (n=10) believe the policy changes will reduce the number of Part D plans offered by their respective organizations, while 8% (n=4) believe it will increase the number of plans they offer .

Additionally, the researchers noted that payers expect changes to IRA Part D to lead to narrower forms, with most payers anticipating forms somewhat (52%) or significantly ( 24%) narrower compared to the current design. Conversely, 20% expect relatively similar coverage from the form.

On the other hand, most payers expect better utilization management due to the increased financial accountability of Part D plans. Specifically, 42% (n=21) expect better utilization management overall use, and 32% (n = 16) plan to better manage the use of expensive medications. Additionally, 16% (n = 8) expect a change on a case-by-case basis, and 10% (n = 5) anticipate no change.

Finally, the researchers found that most payers believe the IRA will lead to an increase in Part D plan premiums, with 8% (n=4) anticipating a premium increase greater than 10%, 40% (n=20) ) expect an increase. from 5% to 10%, with 18% (n = 9) anticipating an increase of up to 5%. They noted that very few payers expect Part D plan premiums to remain at their current levels (12%, n=6), and no payers expect premiums to decline below current levels.

The researchers also acknowledged the limitations of their study, one being that the survey responses reflected a selective perspective because they came from a small sample size; Due to the small sample size, results may not be generalizable to all payers. Likewise, because the sample consisted only of people within the Cencora Managed Care Network, it did not represent the views of stakeholders outside of it.

Despite these limitations, the researchers noted that the survey clearly showed that U.S. payers expect IRA to have a financial impact on Part D plans, but additional research is needed to better understand the exact impact.

Most payers anticipate increased Part D premiums and greater use of utilization management strategies to contain costs, both of which have potentially negative implications for patient access and affordability, the authors wrote. Additional analysis is needed to examine the extent to which these changes will impact patient access to treatments and how these perspectives evolve over time.

Reference

Ford C, Westrich K, Buelt L, Loo V. Payer Reactions to Implementation of the Inflation Reduction Act: Predicting Future Changes to Medicare Part D Plans. Presented at: AMCP Nexus 2023; October 16-October 19, 2023; Orlando.