As we continue our journey to empower patients, we’re excited to share insights from the second edition of our webinar series on changes to Medicare passed as part of the Inflation Reduction Act (IRA). If you missed the webinar, you can register here to watch it on demand.
Webinar Panel
We were thrilled to have an expert panel to inform us about the changes the IRA has started in the Medicare Program. Our experts included: Gavin Clingham, Director of Public Policy, Alliance for Patient Access; Liz Helms, Founder and Director, Chronic Care Policy Alliance; Adina Lasser, Public Policy Manager, Alliance for Aging Research; Michaela Sims, President, Sims Strategies; Michael Ward, Vice President of Public Policy and Government Relations, Alliance for Aging Research and Tiffany Westrich-Robertson, CEO, AiArthritis.
Changes to Medicare
In 2025, several new programs and changes to plans and coverage will take effect and are likely to affect everyone with Medicare coverage. Medicare’s Open Enrollment period runs annually from October 15 to December 7. It is a crucial time for beneficiaries to review and make changes to their coverage. Here are critical changes to look at further and assess how they might affect you:
- Medicare Prescription Payment Program (Smoothing): The Centers for Medicare & Medicaid Services (CMS) issued new guidance on the Medicare Prescription Payment Program, or “smoothing.” This program is designed to help beneficiaries manage out-of-pocket costs for prescription medications by spreading payments over the year. The program might not be beneficial to everyone, so it’s essential to understand how this program works and how it can benefit you. If you want to participate in the program, you must opt in.
- Alliance for Patient Access
- $2,000 Out-of-Pocket (OOP) Cap: The IRA introduces several updates to Medicare Part D, including a cap on OOP costs of $2,000 annual on medication expenses, which is a significant step toward helping older adults and those with chronic illnesses manage their healthcare costs. However, please note that this only affects medications you get at the pharmacy counter. Medications you receive in a provider office or infusion center are paid for under Part B and are NOT included in the cap!
- Medication Price Negotiations: The new changes also allow Medicare to negotiate medication prices for a limited number of high-cost medications. The first 10 medications have been negotiated. It is unknown exactly how the negotiations will affect Medicare, the cost of medication, the availability of medications, or the cost of plans. As part of your review, be sure you check that your medications will continue to be available to you and that if you change plans, you will not need to requalify to continue receiving your medications.
- Partnership to Fight Chronic Disease
- Increased Medication Prices: One of the highest-profile changes under the IRA is the introduction of “negotiated drug prices.” During our webinar, experts discussed the pricing results for the first 10 medications under this program. These changes are set to take effect in 2026. Beneficiaries could see a direct impact on their out-of-pocket costs
- Alliance for Aging Research
- Barriers to Access Could Increase: The program could also have broader implications for access. CMS has warned that plans could implement increased utilization management or formulary changes due to the negotiations. These types of changes can serve to delay or hinder access through denial of treatment or by creating more steps before accessing treatment. Staying informed about these updates can help you make more cost-effective choices during open enrollment in 2026 and beyond.
- Increased Health Plan Premiums: While premium rates for 2025 Medicare plans are expected to be announced later this month, the Biden administration announced a premium stabilization program in July, which provides an additional payout to plan providers. This program is aimed at staving off premium increases that plans are expected to propose due to the IRA redesign of Part D and the shift in cost to the plans.
Resources for Open Enrollment
- Medicare.gov
- My Patient Rights
- Alliance for Aging Research
Patients Can Take Action: Your voice matters, especially during times of change. Our recent webinar highlighted opportunities for patient engagement, encouraging beneficiaries to speak up and ensure that their needs are considered as the IRA’s provisions are implemented. You can share your story and experience in many ways including talking to your legislators, speaking or submitting testimony as CMS reviews the next set of medications, joining the Patient Inclusion Council (PIC) or responding to their survey which will help them share the patient perspective as states introduce Prescription Drug Affordability Boards (PDABs) and CMS.
- EACH PIC Coalition
Your voice is powerful—use it to advocate for the healthcare you deserve. Whether through community forums, healthcare advocacy groups, or direct communication with lawmakers, your input can help shape the future of Medicare.
Stay tuned for more updates, including the rate announcement for 2025 Medicare coverage and updates on Medicare Advantage Open Enrollment, which runs January 1-March 31. Additionally, CMS is slated to announce the next round of medications subject to Medicare negotiation in February 2026. We will share more at that time.
If you missed the webinar, you can register here to watch it on demand. Let’s make sure that every patient has the knowledge and support they need to navigate these changes confidently.