Medicare AdvantageCoverageMedium impact
Inflation Reduction Act (IRA)
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Endocrinology·Provider Update
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
The Inflation Reduction Act caps insulin costs at $35 per month for Medicare Advantage members starting January 1, 2023 (Part D) and July 1, 2023 (Part B), and eliminates out-of-pocket costs for ACIP-recommended adult vaccines under Medicare Part D. Members may receive automatic refunds for January 2023 insulin overpayments.
Action Required
Immediately: Billing team must verify insulin claims for Medicare Advantage members are processed with $35 maximum cost-share and adult vaccine claims (ages 19+) are processed at $0 cost-share. Monitor for automatic reprocessing of January 2023 insulin overpayments within 30 days. Update patient education materials to reflect new cost-sharing limits.