At AMCP, we find real value in gathering people together and facilitating discussions about important issues. Last week, we hosted our inaugural workshop on the Inflation Reduction Act (IRA), convening stakeholders from across healthcare fields to share ideas and concerns as well as develop recommendations about implementing the IRA. The IRA is a landmark piece of legislation with important implications across managed care pharmacy and the larger healthcare industry. This workshop reinforced that there is still a great deal of uncertainty as key milestones approach.  

Looking back, the day was full of information and productive conversations, covering a wide range of germane topics. For example, we heard from CMS officials on how the IRA should and can be implemented, with a focus on inflationary rebates for Medicare Part B and D drugs when drug prices surpass inflation and out-of-pocket smoothing in Medicare Part D.  

The issues related to out-of-pocket smoothing are emblematic of the larger challenges facing the IRA. We don’t know many of the specifics because the rules remain uncertain; there is also a fairly aggressive timeline for implementation. Despite these potential frustrations, we at AMCP truly believe in stakeholder engagement. As we heard from CMS, they are looking for industry input and comments; the conversations we had during our workshop breakout sessions — and the recommendations we gleaned — are precisely the type of engagement that will help lead to constructive solutions.  

The Drug Price Negotiation program is another crucial area where the IRA will affect the Medicare program. Fortunately, we heard some compelling insights from Melissa Andel of CommonHealth Solutions. And again, as importantly, we heard from our many stakeholders. But the only way to adequately address concerns is first to identify them. Among the many concerns identified are the burden of gathering negotiation factor data, the difficulties in identifying therapeutic alternatives, and uncertainties around the negotiation process. Thanks to our participants, we’ve taken the crucial first step toward addressing these problems.  

Other highlights include:  

• Identifying key challenges related to providing information about research & development costs under the drug price negotiation program. 
• The need for robust patient education addressing who will benefit from out-of-pocket smoothing and how they can enroll.
• Discussing the important role of community and retail pharmacists in the patient experience when enrolled in smoothing. 

As we’ve said before, AMCP’s work related to the IRA is a multi-step process. We are eagerly awaiting Sept. 1, when CMS will release the initial list of ten Medicare Part D drugs selected for negotiation for 2026. And this is just one key milestone we’ve got our eyes on. There will be much to discuss at our next IRA workshop in November. But please, should you have any thoughts or ideas beforehand, reach out. It is that sort of proactive engagement that will get us all closer to actionable recommendations and move us closer to an IRA that works smoothly and efficiently for patients.  

View IRA Blog Part 2

Susan A. Cantrell, MHL, RPh, CAE
Chief Executive Officer
Published on Nov. 17, 2023

With the implementation of the IRA well underway, the Drug Price Negotiation program, Part D redesign, and inflationary rebate provisions are painting an exceedingly complex landscape for pharmaceutical companies, health plans, PBMs, patients, and government stakeholders. That’s why your organization will want to take advantage of an opportunity to help shape the implementation of the IRA. Join a select group of colleagues at AMCP’s second IRA Virtual Workshop Series on Nov. 15, 2023. Your organization’s attendance grants access to a roundtable of managed care experts and thought leaders. This “surround-sound” initiative grants the opportunity to be heard, navigate the IRA and its downstream effects, and unpack the law’s key provisions. These workshops offer your organization the opportunity to lend its expertise and have its voice heard in the discussion around the IRA. 

Contact @email now to secure your organization’s spot.