Medicare AdvantageCoverageMedium impact
Inflation Reduction Act effective 1/1/23 for Medicare Advantage plans
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
The Inflation Reduction Act introduces two key changes for Medicare Advantage plans effective January 1, 2023: insulin costs are capped at $35 per month supply (with Part B insulin cap starting July 1, 2023), and all ACIP-recommended adult vaccines under Medicare Part D now have $0 out-of-pocket costs.
Action Required
Immediately: Billing team must update patient cost estimates for insulin prescriptions to reflect $35 monthly cap for Medicare Advantage Part D members. Update vaccine billing to reflect $0 copays for ACIP-recommended adult vaccines under Medicare Part D, excluding BCG, ROTATEQ, and DENGVAXIA which continue under current formulary status. Note that January 2023 insulin claims may initially process above $35 but will be automatically reprocessed within 30 days with refunds issued to members.