Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

​Coinsurance for select Part B drugs will decrease on April 1 if the price has outpaced inflation​

March 31, 2023

​Beginning April 1, 2023, the coinsurance for select Part B rebatable drugs will be reduced if the drug's price has increased at a faster rate than inflation. This benefit falls under the Part B Rebatable Drug Coinsurance Adjustment provision of the Inflation Reduction Act.  

CMS will publish the adjusted beneficiary coinsurance for each Part B rebatable drug in the quarterly pricing files posted on the CMS website, which will note:

  • “Inflation-adjusted coinsurance" in the Notes column if the coinsurance for a Part B drug or biological should be less than 20 percent of the Medicare Part B payment amount.
  • Your Medicare portion of payment and the patient coinsurance percentage for each HCPCS code of a drug or biological, so you can charge patients correctly.

Starting April 1, 2023, when a Part B coinsurance lower than 20 percent applies for a rebatable drug for a calendar quarter:

  • You must charge patients the correct amount of coinsurance.
  • The Medicare portion of your payment will be increased for the difference between the Medicare Part B payment amount and patient coinsurance, minus any Part B deductible and sequestration.

For the time period of April 1 to June 30, 2023, CMS has published the list on its website, which contains  the 27 Part B rebatable drugs that have an adjusted coinsurance rate based on the inflation-adjusted payment amount.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.