NCPA advocates for pharmacy in calls with CMS, HHS, White House

NCPA May 26, 2023

Starting in 2025, Part D patients can elect to have cost-sharing “smoothed” out over the course of the benefit year under the Inflation Reduction Act and can elect to pay their cost-sharing in monthly installments. Out-of-pocket costs for Medicare Part D beneficiaries will be capped at $2,000 per year in plan year 2025. In subsequent years, the $2,000 threshold will be increased at the rate of growth for the Part D program. On May 24, NCPA’s Steve Postal attended an IRA workshop hosted by the Centers for Medicare & Medicaid Services and its contractor, Mathematica, and focused his comments on potential plan behavior that may add administrative burden to pharmacies. He also warned CMS to be wary of plan and PBM efforts to use education on smoothing to steer patients to PBM-affiliated pharmacies The following day, on May 25, NCPA’s Steve Postal and Anne Cassity spoke with the Department of Health and Human Services and White House officials about the IRA and the need for standardized educational materials published by HHS that alert patients to the copayment smoothing provision. They reiterated NCPA concerns that such educational efforts would add administrative burdens to pharmacists. Postal also asked HHS officials to report on the status of the HHS Bridge program that would provide COVID-19 vaccines from pharmacists to uninsured patients. HHS responded that it will be following up with more information on the copayment smoothing provision, as well as the HHS Bridge program.