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Rebates In Part D: HHS Argues Scrutiny Of Impact On Formularies, Beneficiaries Not Needed Now

 
• By Cathy Kelly

New GAO recommendations springing from recent Medicare Part D cost and access trends related to rebates may not be relevant going forward because the IRA price negotiation program and benefit redesign will significantly change the landscape, HHS says.

GAO Digs Into A Hot Topic • Source: Shutterstock

The Centers for Medicare and Medicaid Services does not need to add an evaluation of the impact manufacturer rebates have on Medicare Part D formulary design and beneficiary costs to its annual formulary review process at this point, the Department of Health and Human Services told the General Accountability Office in response to a recent GAO report.

GAO Report Highlights

  • Part D plans received $48.6bn in manufacturer rebates in 2021.

  • Three drug classes accounted for 73% of rebates: antidiabetics, anticoagulants and respiratory agents.

    • ...

CMS conducts an annual clinical formulary review in Part D that includes evaluating whether formularies include commonly prescribed drug classes. It does not currently focus on rebating.

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