27 Medicare Drugs With Price Hikes Above Inflation

CMS will not identify which medications paid for under the Part D prescription drug benefit will be subject to a rebate until later this year. Part D medications are generally taken by patients in pill form and represent the majority of prescription drugs used by Medicare enrollees.

According to CMS, Medicare enrollees who need one of the 27 Part B drugs identified could save between $2 and $390 per average dose of these medicines. How much a beneficiary pays for their prescription drugs depends on their Medicare coverage. For example, the 20 percent Part B copay is covered for many people who have a Medicare supplemental, or Medigap, policy. And the copay and coinsurance for people with Medicare Advantage plans varies depending on the plan and where someone lives.

Many of the drugs included in this list of 27 are expensive. For example, total spending on Padcev, used to treat cancer, averaged nearly $93,000 per beneficiary in 2021 and resulted in nearly $155 million in Part B spending. The average cost of another cancer drug, Elzonris, was nearly $410,000 per beneficiary in 2021.

“This is a new protection for people who were previously exposed to these high price increases,” Purvis says. “Now your coinsurance is going to be based on what the drug’s price would have been had it increased by no more than inflation.”

Overall prices could drop

If the rebate provision in the new law had been in effect between July 2021 and July 2022, 1,216 products may have had to pay the new rebates because their price increases exceeded the inflation rate of 8.5 percent, an analysis from the Department of Health and Human Services (HSS) shows. The average price increase for these drugs was 31.6 percent. This HHS report analyzed prescription drugs for both Part B and Part D.