OPINION
agencies and DME ( durable medical equipment ) companies : that ’ s the size of Greece ’ s economy .
The law also requires drug companies to pay rebates to Medicare when the drug prices increase faster than the rate of inflation , for certain drugs . Small biotech companies have a process to apply for exceptions to negotiation for their unique specialty medicines .
Another excellent adjustment to Medicare D is that Part D plans , from 2024 through 2029 , are unable to raise their premiums by more than 6 % per year . As of 2025 , Part D costs – including Medicare Advantage plans – for covered prescription drugs will be capped at $ 2,000 , and the payments from patients can be spread out through the year . Certain recommended vaccines will be free to Medicare D users – shingles , flu , pneumonia , etc .
Patient advocates want Medicare to clarify that orphan drugs ( drugs whose development and distribution have been minimized due to perceived lack of commercial gain ) will be exempt from price negotiation until they are usable for more than one disease . They fear that the small number of people who utterly depend on these will suddenly have no drug at all , if the company ’ s bottom line keeps shrinking . They are grateful to the scientists and physicians who have struggled to invent these medicines and worry that any loss of profit will snatch their medical lifelines away . They wrote in to Medicare with explicit pleas to spare these special treatments from negotiation . They rightly asked that these drugs also be exempt from any sort of preauthorization decision tree : only one key will turn the lock for their ailment , and that key should be available to
all who need it .
Pharmacy benefit managers ( PBMs ) are some of the largest , sharpest thorns in both doctors ’ and patients ’ sides . We together know what is best , not some person in the computer salt mine , forced to deny things , day in and day out , to sick human beings . I would like to know what percentage of these folks experience clinical depression . PBMs can be murky , with rebate negotiation and administrative fees and the ubiquitous “ utilization management ,” otherwise known as No Not Today and his buddy , Please Go Away .
The most popular provision from the Inflation Reduction Act is likely the $ 35 / month cap on the cost of each Medicare-covered insulin . Recommended vaccines are now free for those with Medicare D – and these aren ’ t things an insurance company can mess with , other than change the types of insulin they carry .
Good medical things are happening from this law , and more and more of them will happen in the coming years . Currently , Medicare has been negotiating with multiple drug companies , and on Sept . 1 , Medicare will publish the “ maximum fair prices .”
I must say , it is refreshing to get to write nice things about the entity that forced me and untold legions of doctors to fill out forms , over and over and over . If age doesn ’ t drive you away from medicine , soon enough the forms will chase you down the street .
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .
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