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Medicare Part D Redesign Could Expand Rebate-Driven Formulary Exclusions In Program

 
• By Cathy Kelly

Increased application of utilization management controls expected as plans face higher costs under the redesign. However, the formulary advantages available to drugs in the protected classes may lead developers to sharpen their focus on those categories.

Formulary Exclusions Less Common In Part D Than The Commercial Market • Source: Shutterstock

Medicare Part D plans will look to tighten their management of drug costs in the next couple of years as the benefit redesign established by the Inflation Reduction Act shifts more of the financial burden of coverage from Medicare to plans.

Starting in 2025, plan responsibility for branded drug costs in the catastrophic phase will increase from the current 15% to 60%, while Medicare’s responsibility will shrink from 80% to 20%.

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