Medicare represents about 30% of the pharmaceutical market. That is a significant muscle to flex in the marketplace. What could that mean to the rest of the market? (Credit: wollertz/Adobe Stock) Medicare represents about 30% of the pharmaceutical market. That is a significant muscle to flex in the marketplace. What could that mean to the rest of the market? (Credit: wollertz/Adobe Stock)

On Aug. 16, 2022, President Biden signed HR 5376, dubbed the "Inflation Reduction Act," into law. Among a host of things, the bill includes health care cost-reducing provisions that have been widely touted in the media as a win for health care consumers. These include:

  • Allowing Medicare to negotiate the cost of a small number of high-priced prescription drugs directly with manufacturers. Price reductions would take effect on 10 Part D drugs in 2026, 15 Part D drugs in 2027, 15 Part B and Part D drugs in 2028, and 20 Part B and Part D drugs in 2029.
  • Capping out-of-pocket insulin costs for Medicare beneficiaries at $35 per month. It is important to point out that this provision does not reduce the cost of insulin, but does reduce the cost for individuals on Medicare using insulin. The cost is simply shifted to the broader base of taxpayers. Insulin likely will not fall under the criteria to be eligible for negotiation.
  • Extending subsidies for the Affordable Care Act (ACA) coverage for an additional three years, through 2025.
  • Requiring drug manufacturers to offer rebates to Medicare if they raise drug prices faster than the rate of inflation.
  • Extending a moratorium on implementing a rule to eliminate safe harbor from the anti-kickback statute for prescription drug rebates.

At a glance, most would surmise these changes have little to do with workers' compensation. In a direct sense, that is true. Indirectly, the extension of subsidies for ACA plans could help keep more people on the health insurance rolls and reduce the risk of uninsured employees claiming a workplace injury simply to get coverage for something they didn't insure and didn't happen at work. That is one potential indirect benefit.

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