Request a call Login

  • The Federal government recently passed the Inflation Reduction Act, which states that prescription drug prices cannot increase more than the current inflation rate. This will have a sweeping effect on those under Medicare who have been paying thousands of dollars for prescription drugs.

    Tens of thousands of Arizonans will gain health care coverage under the Inflation Reduction Act. The act’s expansion will improve health outcomes, save lives, improve financial security, and narrow disparities and access to care.

    Cutting Prescription Drug Costs

    One of the major declarations the bill makes is capping the Medicare beneficiary’s out-of-pocket costs in Part D to $2,000. Arizonans will no longer pay more than $2,000 on prescription medications. An additional benefit is capping insulin copays at $35 per month. This will help roughly 63,000 people who live in the state.

    The act will also help those with low incomes by providing extra help to pay for prescription drugs. It expands eligibility for full Part D low-income subsidies, known as Extra Help. Roughly 8,100 Arizona Medicare beneficiaries received partial Extra Help and due to the act, they could receive full Extra Help benefits. Individuals under Medicare Part D must pay for a portion of vaccines out of pocket. This legislation will make sure there are no out-of-pocket costs for Part D constituents which will affect 88,000 individuals.

    Lowering Health Insurance Premiums And Expanding Coverage

    About 200,000 Arizonans with marketplace coverage are saving an average of $830 per year from the American Rescue Plan (ARP) subsidies that the Inflation Reduction Act would continue. Among those benefiting, small business owners and those that are self-employed will benefit the most due to their usage of the Affordable Care Act. In addition, it benefits middle-income individuals who have retired or don’t have health insurance through their companies.

    The Benefits Of Partnering With GMS

    With the Inflation Reduction Act being passed by Congress, GMS can manage the complexities. It will ensure that small businesses are optimizing their gains and participating in the act. Our RX specialists can help you navigate how this can help you and your business and ensure your premiums are as low as possible. We offer flexibility, control of premiums, access to data and networks, and overall options that you can’t find elsewhere. Contact GMS today.

  • On August 12th, 2022, the Inflation Reduction Act went into effect. As inflation continues to rise throughout the United States, the act calls for a significant reduction in prescription drug pricing. Various implications come along with the new federal drug price as it moves across healthcare systems.

    Three Provisions

    A recent webinar panel discussed three major changes in prescription drug pricing:

    1. Price negotiation – This allows the government to regulate certain drugs under Medicare and the Drug Price Negotiation. This pushes the government to establish a maximum fair price (MFP) for certain prescription drugs. As a result, H.R. 3 requires the Secretary to consider research and development costs, market data, production and distribution costs, and therapeutic alternatives. 
    2. Inflation penalties – Pharmaceutical manufacturers must pay rebates on drugs covered by Medicare Part B and Part D if the drug price rises faster than the inflation rate. 
    3. Medicare Part D – This creates a $200,000 out-of-pocket cap on Part D prescription drug spending. 

    Industries Affected

    Due to the creation of this revision, there are five key sectors of the healthcare system that are affected, including: 

    • Drug manufacturers 
    • Payers
    • Providers
    • State Medicaid agencies
    • Patients

    Deduction Of Manufacturer’s Revenue

    Drug manufacturers not subject to negotiation will see a decrease in revenue as others choose to decrease their prices. Due to inflation caps, price increases will be limited. A significant benefit of these regulatory changes will be a smaller out-of-pocket cost for consumers.

    Medicare Part D Cap

    The regulations have established that Part D beneficiary premiums are capped for 2024 through 2029. In addition, there will be an annual beneficiary cost-sharing cap effective in 2025. This will also eliminate catastrophic beneficiary cost-sharing for 2023 and 2024. The negotiated drug prices and inflationary rebates may reduce Medicare Advantage plan costs for Part B drugs.

    The Impact GMS Has On Your Business

    As a business owner, you want to ensure that your benefits plan continues to get you the lowest rates. When you partner with GMS, you gain access to an Rx Specialist who can support you and your employees find the most cost-effective option. Additionally, we offer control of premiums, access to data and networks, and options you can’t find elsewhere. Learn more today!

  • On August 8th, 2022, the Senate approved bill H.R. 5376, the Inflation Reduction Act of 2022. This bill will make a historic down payment on deficit reduction to fight inflation, invest in domestic energy production and manufacturing, and reduce carbon emissions by 40 percent by 2030. In addition, the bill will allow Medicare to negotiate prescription drug prices and extend the expanded Affordable Care Act Program (ACA) for three years.

    While Democrats and supporters of the legislation believe it would lower health care costs, prescription drugs, and energy costs, and make the U.S. tax code fairer, others disagree. Individuals argue that the new spending would further aggravate inflation and stifle growth. While the bill must still pass in the House of Representatives and be signed by President Joe Biden, it’s more than likely to become a law.

    What This Means For Small Business Owners

    To stay compliant, small business owners must keep up with changing laws and regulations. Following the passing of the Inflation Reduction Act, it’s important to understand the following provisions:

    • 15% minimum tax on corporations with over $1 billion in revenue 
    • 1% excise tax on corporate share buybacks
    • $80 billion more in IRS enforcement

    The following are health care provisions: 

    • Extend the ACA subsidies through 2025
    • Allow Medicare to negotiate drug prices, starting with 10 drugs in 2026
    • Cap Medicare recipients’ drug expenditures at $2,000 per year

    Uncertainties Relieved Through GMS 

    Despite the uncertainty surrounding the new Senate bill, GMS experts are ready to help your small business. We provide you with resources and guidance to get you through unprecedented times. Our benefits services allow your business to offer competitive, cost-effective benefits such as health insurance while you focus on what you do best. Get back to focusing on what’s important, your business. Contact us today.