HHS Actions to Increase LIS Enrollment
Among other changes aimed at reducing drug costs for both Medicare beneficiaries and the Medicare program at large, a provision of the Inflation Reduction Act of 2022 (IRA) expands access to the Part D Low Income Subsidy (LIS, or “Extra Help”) to help people meet the costs of medications. Starting in 2024, eligibility for the full LIS benefit will be expanded to individuals up to 150% of the Federal Poverty Level (FPL), who meet the requisite asset test (now, the full LIS is only available to individuals with income up to 135% of FPL, with a partial subsidy available for those up to 150%).
According to the Medicare program, up to 3 million individuals with Medicare could benefit from the LIS now but aren’t currently enrolled. In order to improve enrollment in the LIS and reach those who might be eligible, the Department of Health & Human Services (HHS), through the Administration for Community Living (ACL) and the Centers for Medicare & Medicaid Services (CMS) recently announced actions the department is taking, as outlined in a Fact Sheet (June 12, 2023).
Additional tools released by HHS include:
- Social Media Toolkit, “Getting Extra Help”: https://www.cms.gov/files/document/extra-help-social-media-toolkit-english.pdf
- Drop-in Article: https://www.cms.gov/files/document/lis-extra-help-article-june-2023.pdf
- New national data from CMS on people with Medicare Part D prescription drug coverage living in the community who currently benefit from Extra Help, those who are expected to save more on prescription drug costs thanks to the program’s expansion in 2024, and those who are likely eligible for Extra Help but not enrolled: https://www.cms.gov/research-statistics-data-and-systems/research/mcbs/data-tables/744519414/mcbs-puf-characteristics-medicare-beneficiaries-low-income-subsidy-enrollment-status-2021
- A revamped Extra Help webpage on Medicare.gov https://www.medicare.gov/ExtraHelp
Lower Costs for Certain Part B Drugs
Another provision of the IRA can lead to beneficiaries paying a lower coinsurance amount for some Part B drugs if the drug’s price increases faster than the rate of inflation. CMS recently announced the list of 43 prescription drugs for which Part B beneficiary coinsurance may be lower during the period of July 1 – September 30, 2023 (see CMS Press Release, June 9, 2023).
Challenges to the IRA
Following a lawsuit filed by pharmaceutical manufacturer Merck challenging the Inflation Reduction Act’s drug pricing provisions, the U.S. Chamber of Commerce also filed a similar suit just days later.
In response to the Merck lawsuit, the Center for Medicare Advocacy issued the following press release titled “Drug Company Sues Medicare to Reverse Gains Being Made in Reining in Drug Costs” (June 6, 2023):
Recently, pharmaceutical company Merck filed a lawsuit against the Medicare program in an effort to stop progress being made on drug pricing in Medicare through the Inflation Reduction Act (IRA), signed into law by President Biden in 2022.
Judy Stein, Executive Director of the Center for Medicare Advocacy, stated: “This is yet another example of an extremely profitable industry going to great lengths to preserve its profits at the expense of a law that takes reasonable measures to rein in the costs of a limited set of drugs that have been on the market for some time.”
The IRA is projected to save the Medicare program billions of dollars, shoring up Medicare’s finances while reducing out-of-pocket costs for people with Medicare. Stein added: “If this suit is successful, it will be bad for Medicare and bad for Medicare beneficiaries.”
June 15, 2023 – D. Lipschutz