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The Inflation Reduction Act: Recasting the Medicare Prescription Drug Plans

Published:February 25, 2023DOI:https://doi.org/10.1016/j.amepre.2023.02.003
      The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), the most substantial overhaul of Medicare since its inception, created Medicare Part D, a heretofore absent voluntary outpatient prescription drug benefit.

      H.R.1 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 108th Congress (2003-2004). https://www.congress.gov/bill/108th-congress/house-bill/1. Accessed August 16, 2022.

      The MMA also saw to the enactment of a noninterference clause according to which “the Secretary [of Health and Human Services (HHS)] may not interfere with the negotiations between drug manufacturers and pharmacies and PDP [Prescription Drug Plan] sponsors and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.”

      H.R.1 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 108th Congress (2003-2004). https://www.congress.gov/bill/108th-congress/house-bill/1. Accessed August 16, 2022.

      This facet of the MMA differed from the framework for both the Department of Defense and the Department of Veterans Affairs, which within their respective systems played an active role in the pricing of their drug formularies. Multiple legislative efforts to abrogate the noninterference clause over the last 2 decades failed to materialize until now. In this current issue, we consider the role of the recently enacted Inflation Reduction Act (IRA) in rescinding the noninterference clause while recasting the Medicare prescription drug plans and the benefits thereof.

      H.R.5376 - Inflation Reduction Act of 2022. 117th Congress (2021-2022). https://www.congress.gov/bill/117th-congress/house-bill/5376. Accessed August 16, 2022.

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      REFERENCES

      1. H.R.1 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 108th Congress (2003-2004). https://www.congress.gov/bill/108th-congress/house-bill/1. Accessed August 16, 2022.

      2. H.R.5376 - Inflation Reduction Act of 2022. 117th Congress (2021-2022). https://www.congress.gov/bill/117th-congress/house-bill/5376. Accessed August 16, 2022.

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