What Are CMS' Part B Rebatable Drugs for 2025?

We’ve got the Centers for Medicare & Medicaid Services’ (CMS) most recent list of Medicare Part B drugs your clients may pay reduced coinsurance for from January through March 2025!

CMS analyzes and announces the Medicare Part B rebatable drugs quarterly. Keep reading to see the latest Part B rebate guidance.

Inflation-Adjusted Coinsurances for Medicare Part B Drugs

As a reminder, Medicare Part B generally covers drugs provided in doctors’ offices and hospital outpatient departments. Part B drugs may qualify for price adjustments as a result of the Medicare Prescription Drug Inflation Rebate provision in the Inflation Reduction Act (IRA).

The provision states that drug manufacturers who increase the prices of their drugs faster than the rate of inflation must reimburse Medicare for the difference. The reimbursement comes in the form of a rebate, hence the name “Part B rebatable drugs.” CMS then passes the savings back to Medicare enrollees through inflation-adjusted Part B coinsurances.

CMS reports that Medicare beneficiaries have seen savings on more than 120 drugs thanks to the IRA’s Medicare Part B inflation rebate program.

Part B Drugs Eligible for Reduced Coinsurance in 2025

On December 20, 2024, CMS announced the 64 Part B prescription drugs that may have lower beneficiary coinsurance rates for January, February, and March due to their prices increasing faster than inflation. CMS states that more than 853,000 Medicare enrollees use these drugs each year.

Note: CMS released information on inflation-adjusted coinsurances via their quarterly Average Sales Price (ASP) public files. Occasionally, CMS updates these after they release them, before the changes go into effect.

Source: CMS.gov

How Much Could Beneficiaries Save on These Prescriptions?

According to CMS Administrator Chiquita Brooks-LaSure, “As we head into 2025, people with Medicare will feel substantial relief from high drug prices. In addition to lower cost-sharing for certain drugs whose prices have increased above the rate of inflation, people with Medicare prescription drug coverage will have their annual out-of-pocket costs capped at $2,000 for the first time. This will be life-changing for people who have been living with high drug costs.”

CMS projects beneficiaries with Medicare who use these drugs during the first quarter may save between $1 and $10,818 per day. It’s important to note, however, that specific savings will depend on the individual and their exact coverage.

For more info on the Medicare Prescription Drug Rebate Program, visit CMS.gov/inflation-reduction-act-and-medicare/inflation-rebates-medicare.