Avila Medicare Solutions

changes in medicare 2023
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In 2023, major changes to the Medicare program in the United States are expected. These changes will have a major impact on Medicare beneficiaries, so it is important to stay abreast of the latest news and updates.

Free vaccines

Another provision of the new law is the free availability to Medicare beneficiaries of adult vaccines recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP).

Some vaccines are already free to Medicare beneficiaries and are covered under Part B. Others are covered by Part D prescription drug plans and require beneficiaries to cover a portion of the cost.

For example, some beneficiaries are eligible for free vaccines under Part B for flu, pneumonia, COVID-19 (initiation and booster vaccines), and hepatitis B, and this coverage will last through 2023. In addition, Part B also covers vaccines needed to treat specific injuries or if you have had direct contact with a disease. Hepatitis A, rabies and tetanus are some of these.

Other vaccines, such as the two-dose Shingrix for shingles, are covered by Part D prescription drug plans, although some plans may impose a cost-sharing requirement. The price of one dose of Shingrix, for example, can reach $$200 per dose. Beginning in 2023, all ACIP-suggested vaccines will be provided at no charge to beneficiaries, regardless of whether they have met their Part D deductible. 

Drug manufacturers face fines for price increases

Another provision of the new law that takes full effect in 2023 requires pharmaceutical companies to reimburse Medicare if drug prices increase above the general rate of inflation.

Beginning in 2023, companies that promote both Part D prescription drugs (purchased at pharmacies) and Part B drugs (generally administered in doctors' offices) will be subject to penalties if they increase prices above the rate of inflation. The companies' reimbursements will be calculated by multiplying the amount Medicare paid for all sales of a drug by the amount by which they increased the price above the inflationary increase.

The goal of this new requirement is to discourage drug companies from raising their prices above the rate of inflation. Between 2019 and 2020, prices for half of the drugs covered by Medicare increased faster than the rate of inflation, according to research by the Kaiser Family Foundation, an independent organization. 

Principles of price negotiations

According to Seshamani, by Sept. 1 Medicare will release the first 10 Part D drugs that, under the new law, will begin a first process in which Medicare will negotiate prices with drug manufacturers. This process "will have a big impact on making drugs more affordable for people with Medicare," Seshamani said.

Negotiated prices for that first group of drugs, to be selected from the 50 drugs on which Medicare prescription drug plans spend the most, will take effect in 2026. 

Stay tuned and feel free to share any questions or comments you may have!

In our next blog we will address other Medicare changes coming this year.

If you need help with Medicare or health plans, call us for free advice. Our local number is 512-520-5957 or you can call us on our toll free number which is 855-GO-AVILA. We are here to serve you.

Do you have any doubts? Call us now.

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