(211) Payer reactions to the Inflation Reduction Act and manufacturer financial assistance

Background: : The Inflation Reduction Act (IRA) introduced key Medicare Part D reforms, including a $2,000 out-of-pocket cap and the Medicare Prescription Payment Plan (MPPP) in 2025, which allows patients to spread out-of-pocket costs throughout the year, as well as Medicare drug price negotiations starting in 2026. While these reforms aim to improve affordability, their impacts on payer strategies and plan design remain unclear.

Objective: : To evaluate the impact of Medicare Part D reforms on plan design and affordability, and to assess payer strategies for 2026 in response to drug price negotiations and manufacturer financial assistance programs.

Methods: : A double-blind, web-based survey of United States healthcare payers was conducted through Cencora’s Managed Care Network research panel in May 2025.

Results: : A total of 40 payers, representing health plans (n=18), integrated health delivery systems (n=14), and pharmacy benefit managers (n=8), shared insights on how the IRA impacts plans and informed predictions for 2026 plan design and strategies. In 2026, half (50%) of payers anticipate adverse financial effects on their portfolio of Part D plans, with 65% planning to consolidate or eliminate Medicare Part D plans to manage financial pressures. Premiums are expected to rise, with 78% of standalone prescription drug plans and 83% of Medicare Advantage plans projecting increases, most commonly up to 10%. Narrower formularies are expected by 85% of plans, with 88% expecting greater use of utilization management tactics. For drugs under Medicare price negotiation, 50% of plans anticipate increased prior authorization and 53% foresee expanded step therapy. Payers perceive the MPPP as confusing for patients (63%) and difficult to implement (48%), though 58% of payers see it as beneficial for patient affordability. Communication strategies on the IRA with providers and patients remain limited, with many payers focusing on mandated updates. Regarding biopharmaceutical-sponsored financial assistance, 25% of payers do not restrict use, while the remainder employ copay accumulators (65%), maximizers (60%), alternative funding programs (20%), or outright deny assistance (8%).

Conclusions: : The IRA’s reforms aim to improve affordability, but they have also created significant financial and operational challenges for payers. Going into 2026, payers anticipate narrower formularies, expanded utilization management, and plan consolidation. Manufacturers must engage payers with innovative strategies to balance affordability and coverage.

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