January 5, 2023
Due to the Inflation Reduction Act (IRA), the Centers for Medicare & Medicaid Services (CMS) made several pharmacy benefit changes to prescription drug plans.
Insulin
In 2022, Premera participated in a senior savings model pilot for our Medicare Advantage plans. This allowed us to limit the cost of insulins for preferred Tier three brands to $35 per month for our members. The IRA includes more insulin cost savings for 2023.
Effective January 1, 2023
- Members will pay $2-35 for a month's supply of non-pump insulins.
- Tier one insulin is $2-$4 and $35 through the gap coverage.
- Tiers three, four, and five are $35 through all phases of coverage.
- Effective July 1, 2023: Traditional pump covered insulin will be $35 for a month’s supply through all phases of coverage.
Vaccines
Currently, members get flu, pneumonia, and hepatitis B at $0 cost share, but the IRA includes additional cost savings. Effective January 1, 2023:
- Members will pay $0 out-of-pocket for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles and tetanus-diphtheria-whooping cough vaccines.
- Members won’t pay any fees associated with the vaccines. CMS plans to release which vaccines will be covered under this new rule.
It’s important to prescribe cheaper, affordable insulins and vaccines to prevent your patients from hitting the gap phase. The costs still apply to their true out-of-pocket costs and can get the member in the expensive coverage gap. Once in the gap phase, your patients will pay much higher cost shares for their other medications.
To learn more about the IRA Medicare changes, visit Medicare.gov.
Premera Medicare Advantage 2023 plan updates
Premera made enhancements to our 2023 pharmacy benefits:
- Moved to a national pharmacy network that includes 67,000 pharmacies. All are preferred pharmacies with preferred copays.
- Moved many drugs to tier one and two. No drug deductibles for tiers one and two.
- Added Airduo, Symbicort, Advair Diskus to tier one drugs.