The Inflation Reduction Act & Treatment Costs

The Inflation Reduction Act, passed in August 2022, includes important benefits for people who receive health coverage through either Medicare or the health insurance exchanges established under the Affordable Care Act (also known as “Obamacare”). Since many people aging with HIV receive health care this way, this article aims to break down how the Inflation Reduction Act may impact you.

Starting in 2023, drug companies will be required to pay rebates to Medicare if the prices of their medications rise faster than inflation; Medicare must cap monthly insulin copays at $35; and it must make vaccines available at no cost to Medicare recipients.

Since the prices of some antiretrovirals have increased at especially high rates, people aging with HIV may see a decrease in their copays for these and other medications if they don’t already receive subsidies through either Medicare’s Part D Low Income Subsidy/Extra Help program and or the federal AIDS Drug Assistance Program (ADAP). These changes could potentially lead to slower medication price increases for people with private insurance plans as well.

Before this bill was passed, it was optional for Medicaid programs to include vaccine coverage, and so this coverage varied by state. But starting in 2023, no-cost vaccine coverage will be mandated for Medicaid plans as well.

The Inflation Reduction Act further decreases medication costs for those on Medicare by capping out-of-pocket medication-related costs for Medicare recipients at about $3,250 in 2024, and then $2,000 in 2025.  It also limits the amount that the cap can increase in future years. People currently receiving full Part D Low-Income subsidies from Medicare will continue to have most of their medication-related costs covered. Starting in 2024, eligibility for the subsidies will expand to people at 135%-150% of the federal poverty level with limited assets.

Beginning in 2026, the federal government will be required to negotiate prices with drug companies for a limited number of medications covered by Medicare. The federal government currently is banned from doing this and, in turn, Medicare has no authority to limit annual price increases by drug companies. While it is still unclear what medications will be subject to these limits, many of the medications prescribed for conditions that often co-occur among people aging with HIV (e.g. Type 2 diabetes or cancer) are among those that account for the largest share of Medicare’s drug-spending. So even if antiretrovirals aren’t included in these limited numbers of medications, people aging with HIV may see decreased costs for other drugs they need to take.

For people buying health insurance through the insurance exchanges, the Inflation Reduction Act extends through 2025 the subsidies that started during the pandemic for those who are eligible.

It can be confusing to try and understand what benefits you may be eligible for, how to apply for them, and whether your Medicare Plan could be violating the law. Consider reaching out to an insurance navigator department at a local community-based organization (CBO) or Federally Qualified Health Center (FQHC). They have certified professionals to support you and make these processes much easier at no cost to you. Some even have free or low-cost legal services if your situation is especially complicated! If you live in the New York City area, GMHC is one of many organizations that may be able to help.