PITTS: The Inflation Reduction Act by Biden is Limiting Seniors’ Access to Medication

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TL/DR –

America’s seniors are facing increasing premiums for their Medicare drug coverage due to new rules from the Inflation Reduction Act (IRA), including significant changes to Medicare’s prescription drug benefit, Part D. Post-IRA, insurers have raised premiums by up to 57% in some states and have restricted access to medicines by implementing prior authorization requirements and steering patients to their preferred treatment options. The number of stand-alone Part D prescription drug plans has decreased by 11% since 2023, with larger decreases seen in plans available to low-income patients receiving subsidies.


Medicare Drug Coverage Premiums Soar Amid New Government Rules

Severe inflation has led to skyrocketing premiums for Medicare drug coverage among America’s seniors, courtesy of the newly implemented government rules, particularly the Inflation Reduction Act (IRA).

The Biden administration introduced the IRA in 2022, featuring significant changes to Medicare’s prescription drug benefit, Part D. However, these changes have resulted in rising costs for seniors, contrary to its intended purpose.

The IRA, currently implemented through the latest draft guidance, has led to insurers under Part D ramping up premiums. According to the Kaiser Family Foundation, monthly charges soared by 21% from 2023 to 2024. Data from HealthView Services reveals even steeper increases across states like California, Florida, New York, Pennsylvania, and Texas.

Insurers are resorting to “utilization management” to limit access to drugs, instating strict prior authorization requirements that can hinder patients from receiving timely treatment. This process means physicians must seek approval from insurers before prescribing certain drugs.

Insurers are also steering patients to preferred treatment options, often disregarding doctor recommendations. In addition, changes to formularies have resulted in recategorizing formerly fully covered medicines as “non-preferred” or “specialty,” thus increasing out-of-pocket charges for patients.

Moreover, some insurers are exiting the Part D market altogether. The number of stand-alone Part D prescription drug plans available to seniors has decreased by 11% since 2023. This reduction has a greater impact on low-income patients receiving subsidies, who have seen their available plans dwindle by 34%.

The recent draft guidance from the Biden administration recognizes these issues but offers no solutions. This lack of action, along with a lack of transparency surrounding the IRA’s overall drug-pricing policies, raises significant concerns among physicians and patients.

In 2021, President Biden asserted that people should not have to choose between rent, groceries, and medication. However, it appears that is the grim reality today for many as the effects of the IRA become increasingly apparent.

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