OBJECTIVES: To consider how the US Inflation Reduction Act (IRA) might impact US commercial payer management of drugs within several disease and therapeutic areas including oncology, diabetes, cardiovascular disease, neurology, immunology, vaccines, generics, biosimilars, orphan drugs, and cell and gene therapies, and to understand how payer management might evolve with the implementation of certain provisions.

METHODS: Details regarding IRA provisions related to specific disease and therapeutic areas were obtained from a review of white papers, press releases, and public domain sources. Interviews with US payers representing a range of commercial payer organizations including national and regional Managed Care Organizations, Integrated Delivery Networks, and Pharmacy Benefit Managers were conducted to obtain input regarding anticipated impact on different disease and therapeutic areas and to gain insights on future implications.

RESULTS: The IRA, signed into law on August 16, 2022, includes several provisions aimed at lowering prescription drug costs for Medicare beneficiaries and reducing federal government drug spend. Certain IRA provisions include the requirement for the federal government to negotiate prices for some Medicare Part B and D drugs with the highest total spend, implementation of out-of-pocket caps for Medicare Part D enrollees, and limitations or elimination of cost-sharing for insulin and vaccines. Although the focus is on Medicare, commercial payers agree that the provisions will impact management of many diseases and therapeutic areas assessed in this research across all US payer channels.

CONCLUSIONS: With Medicare negotiating lower drug prices, these savings may shift to commercial insurers, leading to higher member costs. This will likely result in stricter management by commercial payers and greater desire to manage costs through implementation of financial or outcomes-based contracts with manufacturers. Commercial payers will be closely following IRA provisions as they are enacted, since its impact will be different across various disease and therapy areas.