Lowering prescription drug costs and health care costs are among the goals of the Inflation Reduction Act.

While changes will not take effect until 2025, what can the biopharmaceutical industry expect?

Keshia Maughn, Senior Principal, Strategic Advisory Services at STATinMED shares some provisions to watch and strategies for consideration.


3 Main Provisions Regarding Access to Care


1. Extension of the Health Exchange Subsidy (Health Insurance Marketplaces)

  • Health Exchange currently provides insurance to 35 million Americans.
  • The extension of the subsidy until 2025 will allow continued access to care and much needed therapies for patients.

2. Medicare Can Negotiate Prices for High-Cost Drugs

Many high-cost products are covered by Medicare Part B, including infusions in oncology and rheumatology.

Studies have shown patients with Medicare are often retirees on fixed incomes; they remain extremely price sensitive when it comes to out-of-pocket (OOP) expenses.

However, if costs for patients are lower, this may create opportunity for branded pharmaceutical products:

  • Increased adherence to therapy means more units dispensed
  • Increased adoption of a branded therapy (which may have previously been outside of the patient’s budget)

Increased access to more effective therapies may improve quality of life and access to care for millions of Americans.

3. $2000 Annual Cap – OOP for Prescription Drugs

We await more details, but this will likely include products covered under Part D or prescription benefit. Drugs covered under medical benefit will be handled differently.

With pricing not taking effect until 2025, the time is now for biopharmaceutical companies to consider their strategies.

Kaiser Family Foundation (KFF)

5 Recommendations for Strategic Planning

1) Gain insight into the percentage of patients within the therapeutic area that are Fee For Service (FFS) vs Advantage

2) Understand annual overall prescription burden for patients within a therapeutic area who are covered by Medicare (FFS and Advantage), for insight into # of patients with OOP expenses over $2000 within a given year

3) Model impact of price on adherence and sales

4) Reassess global markets and strategies

5) Renegotiate formulary positions for Advantage plans (as appropriate)

One of the unique things about STATinMED RWD Insights is our ability to capture populations with Medicare Advantage and FFS, as well as Medicaid by state and provide comprehensive data and analyses.

As real-world evidence authorities, STATinMED discovers data, develops insights, and delivers value.

Contact STATinMED today to schedule a complimentary needs assessment. Email [email protected] to get connected to a STATinMED Strategic Advisory Services team member.

Keshia Maughn, MPH

Senior Principal, RWE

Keshia Maughn, MPH, has in-depth skills and experience in managing outcomes research projects across therapeutic areas including oncology, immunology, women’s health, neurology, and endocrinology. With over 10 years of experience in the application of real-world evidence for advanced analytics projects, Ms. Maughn has led a global research team in HEOR and Market Access engagements. She has vast experience in econometrics and supervised machine learning techniques on a variety of data sources including open and closed network claims data, EHR data, laboratory, and genomic data. Ms. Maughn is a subject matter expert in the methodology design and the application of machine learning to provide the evidence necessary to support value communications.

As real-world evidence authorities, STATinMED Research discovers data, develops insights and delivers optimal solutions to help life science companies realize maximum value. 

Many thanks again to you and the entire STATinMED Research team for your help with the cohort comparison and timeline. It means a lot to us.
— Oncology Global Patient Outcomes Executive Real World Evidence at global biopharmaceutical company

We understand real-world evidence and solve problems with confidence. Contact the STATinMED Business Development team to learn more! 

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