Advocacy Resource: Ensuring the Medicare Drug Negotiation Program Prioritizes Families and Consumers

The Inflation Reduction Act of 2022 (IRA) was a critical moment in the effort to achieve lower and more affordable drug costs. Most notably, the IRA finally gave Medicare the authority to negotiate prices for a select group of high-cost drugs in Medicare Part D and later Part B. However, the fight does not end with this legislative victory. To ensure the IRA truly results in lower drug prices for people who rely on Medicare, it is critical for health advocates to weigh in as the Biden Administration, and specifically the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services, implements the law through regulatory and sub-regulatory processes. The stakes are high. Big drug corporations and their army of lobbyists have publicly indicated they will use every opportunity to weaken the law.

In this resource, Families USA provides advocates with helpful information and background on the drug pricing provisions of the IRA, including a timeline of key dates when important public commenting opportunities will arise, an overview of the IRA’s statutory language, and a detailed outline of key regulatory decisions that are most important for advocates to engage with CMS and the Administration on. These key decisions include the following:

1. Whether CMS continues to give consumer and patient advocates an opportunity to review and comment on negotiation policy decisions;
2. The process CMS uses to calculate a maximum fair price for the group of drugs whose high prices it chooses to negotiate;
3. How CMS ensures that information from drug manufacturers is accurate and complete;
4. The amount of detail and the manner in which CMS publicizes the methodology and other negotiation policy decisions;
5. How CMS uses the renegotiation process when negotiated drugs change in ways that warrant an updated maximum fair price.

It took a broad and powerful coalition of partners, advocates, and public interest groups to pass the sweeping prescription drug reforms in the IRA. It will take a similar level of mobilization and engagement once more to ensure the IRA is implemented in a way that prioritizes families and consumers, not drug corporations and their industry lobbyists. Families USA looks forward to continuing our work with our partners and advocates to ensure strong implementation of the IRA and help millions of older adults and people with disabilities who rely on Medicare get closer to truly affordable and accessible health care.

If you are interested in partnering with Families USA on this important initiative or if you have any questions about this resource, please contact Bailey Reavis (Breavis@familiesusa.org) or Aaron Plotke (APlotke@familiesusa.org).