"Section 1860D-2(b)(9) of the Social Security Act (the Act), as added by section 11406 of the IRA, imposes a $35 monthly limit on cost sharing for covered insulin products throughout all phases of the Part D benefit.Or in more user-friendly Medicare terms:
Subparagraph (E) of new section 1860D-2(b)(9) provides a three-month period (January 1, 2023 through March 31, 2023) during which a Part D sponsor may retroactively reimburse beneficiaries within 30 days for amounts paid in excess of the $35 cost sharing maximum in the event that the Part D sponsor has not yet adjusted its claims adjudication systems to implement the new insulin benefit at the point of sale. During this time, a beneficiary may pay the higher plan cost sharing at the point of sale, and the plan must refund the difference between that higher amount and $35 to the beneficiary within 30 days."
"If you get a Part D-covered insulin product and pay more than $35 for any month’s supply between January 1, 2023 and March 31, 2023, your Part D plan must reimburse you within 30 calendar days for the amount you paid that’s over $35 per month’s supply.
(Part D plans have until March 31, 2023, to update their systems to make sure you’re charged the correct amount.)
If you haven’t received reimbursement within 30 days, contact your plan."
"[S]ection 1860D-2(b)(8) of the [Social Security Act], as added by section 11401 of the [Inflation Reduction Act], requires the elimination of beneficiary cost sharing for ACIP-recommended adult vaccines administered in accordance with the ACIP recommendation (hereafter referred to as “ACIP-recommended vaccines”) under a Part D plan throughout the entire Part D benefit beginning January 1, 2023. Unlike the insulin benefit, the statute does not incorporate a three-month grace period for plans to implement the changes to this vaccine coverage."