As a result of the 2022 Inflation Reduction Act (IRA), Medicare Part D prescription drug enrollees can now “benefit from lower prescription drug costs and a revamped drug program.”
However, according to Mark Miller of the New York Times, awareness of these changes remains surprisingly low, as shown in a recent survey by the Kaiser Family Foundation (KFF).
This week’s blog aims to raise awareness about the IRA’s benefits for Medicare enrollees, both now and in the future.
According to the Centers for Medicare and Medicaid Services (CMS), “the Inflation Reduction Act provides meaningful financial relief for millions of people with Medicare by improving access to affordable treatments and strengthening the Medicare Program both now and in the long run.”
CMS further adds, “The new drug law makes improvements to Medicare that will expand benefits, lower drug costs, stabilize prescription drug premiums, and enhance the Medicare program.”
Key program benefits include:
- Beginning January 1, 2024: Medicare patients with high prescription drug costs will no longer face out-of-pocket costs after reaching the catastrophic phase of Medicare Part D. KFF estimates a cap of approximately $3,250 for 2024 for those taking only brand-name drugs.
- Expanded Low-Income Subsidy (LIS or “Extra Help”): Starting in 2024, more individuals with incomes up to 150% of the federal poverty level will qualify for extra assistance.
- A yearly out-of-pocket cap: In 2025, Medicare drug costs will be capped at $2,000.
- Free access to recommended adult vaccines without cost-sharing.
- Insulin at $35/month per covered prescription.
Additional IRA provisions include:
- Medicare Drug Price Negotiation: Medicare will have the power to negotiate lower prices on select high-cost, single-source brand-name drugs covered under Medicare Part B and Part D.
- Inflation Rebates: Drug companies that raise prices faster than inflation will be required to provide Medicare with a rebate.
- Changes to Medicare Part B: The IRA will also increase access to biosimilars and cap insulin costs at $35/month for insulin used in durable medical equipment pumps.
For more details on the IRA’s changes to Medicare, visit CMS.gov.
What is the Extra Help Program?
The Extra Help Program assists people with limited resources in paying for Medicare Part D coverage costs such as premiums, deductibles, and coinsurance. Beginning in 2024, the Inflation Reduction Act will expand the program to cover more prescription drug costs for qualifying individuals.
In 2024, the program will provide:
- $0 Medicare drug plan premium.
- $0 plan deductible.
- Reduced costs for both generic and brand-name drugs.
Miller also highlights two major changes coming in 2025: out-of-pocket spending will be capped at $2,000, and enrollees will be able to spread these costs over the year by setting up a payment plan with their Part D insurer.
More information on the Medicare Prescription Payment Plan is available on the CMS Fact Sheet.
Currently, about 300,000 low-income individuals are enrolled in the Extra Help program and will benefit from expanded coverage, including no deductibles, no premiums, and reduced copays for select medications. However, 3 million more are eligible but have yet to enroll. Some have been automatically enrolled, but this doesn’t apply to everyone.
If you’re unsure whether you qualify for Medicare’s Extra Help program or need assistance with applying, visit the CMS website.
DREAMM-7 Trial: Promising Results
This week, GSK released interim analysis results from the DREAMM-7 phase III clinical trial, which assessed the safety and efficacy of belantamab mafodotin combined with bortezomib and dexamethasone (BorDex) versus a combination of daratumumab and BorDex in relapsed/refractory multiple myeloma patients who had received at least one prior line of therapy and experienced disease progression.
DREAMM-7 represents a head-to-head comparison of Blenrep (belantamab mafodotin, an anti-BCMA drug conjugate) with Velcade (bortezomib) and dexamethasone (BorDex) against daratumumab (an anti-CD38 monoclonal antibody) plus BorDex for second-line or later treatment of relapsed/refractory myeloma.
Key findings presented at the American Society of Clinical Oncology (ASCO) Plenary Series on February 6, 2024, include:
- With a median follow-up of 28.2 months, progression-free survival (PFS) was 36.6 months for the belantamab + BorDex group, compared to 13.4 months for the daratumumab + BorDex group—a nearly threefold improvement with a 59% reduction in the risk of disease progression or death (P < 0.00001).
- Improved deep responses, including complete response (CR), stringent complete response (sCR), and MRD negativity, were observed with the belantamab + BorDex combination.
- There was a clear trend toward longer duration of response (DOR) and overall survival (OS) with the belantamab + BorDex treatment.
These findings highlight belantamab + BorDex as a potentially transformative treatment option, especially given that daratumumab + BorDex is considered a current standard of care (SOC).
According to Dr. María-Victoria Mateos, Principal Investigator of the DREAMM-7 Trial, “These results show that belantamab mafodotin in combination with BorDex offers significant improvements over the daratumumab-based regimen in second-line multiple myeloma treatment. Anti-BCMA therapies are improving outcomes for myeloma patients, and an off-the-shelf option like belantamab mafodotin could change the treatment landscape at or after first relapse.”
The results of the DREAMM-7 phase III trial will be shared with global health authorities. There is hope this promising treatment will soon be widely available.
The Bottom Line
2024 has kicked off with positive news for the myeloma community. There’s reason for optimism on both the healthcare and research fronts, and we look forward to more advancements in the coming months. Let’s continue to stay hopeful!
