We have the latest update from the Centers for Medicare & Medicaid Services (CMS) on Medicare Part B drugs that may qualify your clients for reduced coinsurance from January to March 2025!
CMS reviews and releases the list of rebatable Part B drugs every quarter. Read on for the most recent guidance on these rebates.
Inflation-Adjusted Coinsurance for Medicare Part B Drugs
Here’s a quick reminder: Medicare Part B typically covers medications administered in doctors’ offices or hospital outpatient settings. Certain Part B drugs may be eligible for price adjustments under the Medicare Prescription Drug Inflation Rebate provision outlined in the Inflation Reduction Act (IRA).
This provision requires drug manufacturers to reimburse Medicare if they raise drug prices faster than the inflation rate. These reimbursements, known as “Part B rebatable drugs,” are provided in the form of rebates. CMS uses these rebates to pass the savings directly to Medicare enrollees through inflation-adjusted Part B coinsurance.
According to CMS, the Medicare Part B inflation rebate program has already helped beneficiaries save on more than 120 medications.
Part B Drugs with Reduced Coinsurance in Early 2025
On December 20, 2024, CMS announced a list of 64 Medicare Part B prescription drugs eligible for lower coinsurance rates during January, February, and March 2025. These reductions apply to drugs with price increases exceeding the rate of inflation. CMS estimates that over 853,000 Medicare enrollees rely on these medications annually.
Important: CMS shares details about inflation-adjusted coinsurance rates in their quarterly Average Sales Price (ASP) public files. Occasionally, these files may be updated after their initial release but before the changes take effect.
Medicare Part B Rebatable Drugs: Q1 2025
| Drug | Inflation-Adjusted Coinsurance Percentage (Normally 20%) |
|---|---|
| Abecma | 19.39% |
| Adcetris | 18.28% |
| Akynzeo Capsule | 19.03% |
| Atgam | 13.04% |
| Aveed | 19.65% |
| Berinert | 19.08% |
| Bicillin C-R | 16.67% |
| Bicillin L-A | 13.62% |
| Blincyto | 19.28% |
| Breyanzi | 19.40% |
| Brixadi (Monthly Dosing) | 19.27% |
| Brixadi (Weekly Dosing) | 19.27% |
| Carvykti | 18.98% |
| Chirhostim | 19.65% |
| Cresemba | 19.85% |
| Crysvita | 18.89% |
| Cyclophosphamide (Dr. Reddy) | 17.03% |
| Digifab | 19.58% |
| Elfabrio | 19.76% |
| Envarsus XR | 19.59% |
| Evenity | 19.48% |
| Folotyn | 19.96% |
| Fosaprepitant | 18.10% |
| Fragmin | 14.97% |
| Fyarro | 19.36% |
| Gemcitabine (Accord) | 10.24% |
| Hizentra | 19.81% |
| Imlygic | 19.31% |
| Ixempra | 19.76% |
| Kepivance | 16.93% |
| Krystexxa | 19.65% |
| Kymriah | 18.09% |
| Kyprolis | 18.73% |
| Leukine | 19.84% |
| Lupron Depot-Ped | 18.86% |
| Meropenem (B. Braun) | 9.50% |
| Minocin | 18.58% |
| Nexterone (Baxter) | 11.89% |
| Nipent | 17.35% |
| Nplate | 18.77% |
| Oncaspar | 19.14% |
| Padcev | 19.07% |
| Panhematin | 19.20% |
| Prolia | 18.24% |
| Qalsody | 19.98% |
| Rezzayo | 19.86% |
| Rybrevant | 19.14% |
| Rylaze | 19.55% |
| Signifor LAR | 15.84% |
| Sotalol (Altathera) | 18.56% |
| Sylvant | 18.80% |
| Talvey | 19.79% |
| Tecartus | 19.48% |
| Tecvayli | 19.98% |
| Tigan | 19.21% |
| Tivdak | 19.50% |
| Tnkase | 19.96% |
| Vectibix | 18.66% |
| Vyepti | 19.42% |
| Vyxeos | 19.63% |
| Xiaflex | 18.46% |
| Yescarta | 19.42% |
| Zerbaxa | 19.59% |
| Zoladex | 18.18% |
Source: CMS.gov
How Much Could Medicare Beneficiaries Save on These Medications?
CMS Administrator Chiquita Brooks-LaSure highlights the significant impact of these savings:
“As we enter 2025, Medicare beneficiaries will experience meaningful relief from high drug prices. Along with reduced cost-sharing for certain drugs that have seen price increases exceeding inflation, Medicare prescription drug coverage will, for the first time, include an annual out-of-pocket cost cap of $2,000. This change will be life-changing for those burdened by high drug costs.”
CMS estimates that beneficiaries using these drugs in the first quarter of 2025 could save anywhere from $1 to $10,818 per day. However, individual savings will vary based on each person’s specific coverage and circumstances.
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For more details on the Medicare Prescription Drug Rebate Program, visit CMS.gov.
Not affiliated with or endorsed by Medicare or any government agency.
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