{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:08:43Z","timestamp":1790165323059,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The Inflation Reduction Act (IRA) of 2022 introduced major changes in the Part D benefit that aim to improve medication access and correct several of the financial misalignments in the current Part D benefit. The changes address financial obligations of Medicare beneficiaries, the federal government, Part D plan sponsors (i.e., insurance companies), and drug manufacturers. The changes include new brand and biologic manufacturer obligations to beneficiaries eligible for the low\u2010income subsidy. Effects on the drug supply chain and stakeholder behaviors remain to be seen but current financial arrangements inform likely responses. Currently, the Pharmacy Benefit Managers (PBMs) nestled between the plans, drug manufacturers, and pharmacies heavily influence manufacturers' list prices and squeeze community pharmacies. With the IRA restructuring of Part D, plans are likely to interject more administrative obstacles before beneficiaries can obtain higher\u2010cost therapies, while drug manufacturers might alter their patient assistance programs. Manufacturers have already begun to change their assistance programs at many safety net pharmacies. Many Medicare beneficiaries who relied on these deeply discounted medications will face significant late enrollment penalties if they do enroll in Part D plans, creating a major barrier to participation. Providers and policymakers should understand the Part D changes and leverage the skills of pharmacists to support community and team\u2010based care that improves access to medications and ensures that medications are doing more good than harm.<\/jats:p>","DOI":"10.1111\/jgs.19355","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T23:41:24Z","timestamp":1736293284000},"page":"1376-1387","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Medicare Part D: Major Shifts With the Inflation Reduction Act and a Way Forward"],"prefix":"10.1111","volume":"73","author":[{"given":"Gina","family":"Upchurch","sequence":"first","affiliation":[{"name":"Senior PharmAssist  Durham North Carolina USA"},{"name":"Department of Public Health Leadership, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Saliba","sequence":"additional","affiliation":[{"name":"Borun Center, Division of Geriatrics University of California Los Angeles  Los Angeles California USA"},{"name":"Geriatrics Research Education and Clinical Center Greater Los Angeles Veterans Administration  Los Angeles California USA"},{"name":"RAND Health Care  Santa Monica California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.11237"},{"key":"e_1_2_10_3_1","unstructured":"Drug Prices: The Role of Patents and Regulatory Exclusivities R46679 February 10 2021 https:\/\/crsreports.congress.gov\/product\/pdf\/R\/R46679\/2."},{"key":"e_1_2_10_4_1","unstructured":"Comparison of State Prescription Drug Affordability Review Initiatives April 1 2024 https:\/\/nashp.org\/comparison\u2010of\u2010state\u2010prescription\u2010drug\u2010affordability\u2010review\u2010initiatives\/."},{"key":"e_1_2_10_5_1","unstructured":"E.Napoletano Struggling With Prescription Costs? Try These 10 Resources Forbes Advisor Updated May 5 2022 https:\/\/www.forbes.com\/advisor\/personal\u2010finance\/save\u2010money\u2010on\u2010prescription\u2010drugs\/."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2024.30.8.883"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15229"},{"key":"e_1_2_10_8_1","unstructured":"Medicare Prescription Drug Improvement and Modernization Act of 2003 (Office of the Federal Register (OFR) National Archives and Records Administration (NARA)) 2003."},{"key":"e_1_2_10_9_1","unstructured":"What Are the Prescription Drug Provisions in the Inflation Reduction Act? March 17 2023 https:\/\/www.kff.org\/slideshow\/what\u2010are\u2010the\u2010prescription\u2010drug\u2010provisions\u2010in\u2010the\u2010inflation\u2010reduction\u2010act\/."},{"key":"e_1_2_10_10_1","unstructured":"J.Cubanski T.Neuman andM.Freed Explaining the Prescription Drug Provisions in the Inflation Reduction Act KFF January 24 2023 https:\/\/www.kff.org\/medicare\/issue\u2010brief\/explaining\u2010the\u2010prescription\u2010drug\u2010provisions\u2010in\u2010the\u2010inflation\u2010reduction\u2010act\/#bullet02."},{"key":"e_1_2_10_11_1","unstructured":"Medicare Improvements for Patients and Providers Act of 2008 (Office of the Federal Register (OFR) National Archives and Records Administration (NARA)) 2008."},{"key":"e_1_2_10_12_1","unstructured":"The Patient Protection and Affordable Care Act (Office of the Federal Register (OFR) National Archives and Records Administration (NARA)) 2010."},{"key":"e_1_2_10_13_1","unstructured":"Bipartisan Budget Act of 2018 (Office of the Federal Register (OFR) National Archives and Records Administration (NARA)) 2018."},{"key":"e_1_2_10_14_1","unstructured":"Budget Reconciliation Act of 2022 (Office of the Federal Register (OFR) National Archives and Records Administration (NARA)) 2022."},{"key":"e_1_2_10_15_1","unstructured":"J.Cubanski Summary of Recent and Proposed Changes to Medicare Prescription Drug Coverage and Reimbursement KFF Updated February 15 2018 https:\/\/www.kff.org\/medicare\/issue\u2010brief\/summary\u2010of\u2010recent\u2010and\u2010proposed\u2010changes\u2010to\u2010medicare\u2010prescription\u2010drug\u2010coverage\u2010and\u2010reimbursement\/."},{"key":"e_1_2_10_16_1","unstructured":"J.Cubanski T.Neuman andA.Damico Closing the Medicare Part D Coverage Gap: Trends Recent Changes and What's Ahead. 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KFF updated January 16 2024 https:\/\/www.kff.org\/policy\u2010watch\/what\u2010are\u2010the\u2010implications\u2010of\u2010the\u2010recent\u2010elimination\u2010of\u2010the\u2010medicaid\u2010prescription\u2010drug\u2010rebate\u2010cap\/."},{"key":"e_1_2_10_29_1","unstructured":"Understanding the Extra Help with Your Medicare Prescription Drug Plan February 2024 https:\/\/www.ssa.gov\/pubs\/EN\u201005\u201010508.pdf."},{"key":"e_1_2_10_30_1","unstructured":"Medicare Prescription Drug Benefit Manual Chapter\u00a013\u2014Premium and Cost\u2010Sharing Subsidies for Low\u2010Income Individuals accessed November 26 2024 https:\/\/www.cms.gov\/medicare\/prescription\u2010drug\u2010coverage\/prescriptiondrugcovcontra\/downloads\/chapter\u201013\u2010premium\u2010and\u2010cost\u2010sharing\u2010subsidies\u2010for\u2010low\u2010income\u2010individuals\u2010v09\u201014\u20102018.pdf."},{"key":"e_1_2_10_31_1","unstructured":"J.CubanskiandT.Neuman Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit KFF April 20 2023 https:\/\/www.kff.org\/medicare\/issue\u2010brief\/changes\u2010to\u2010medicare\u2010part\u2010d\u2010in\u20102024\u2010and\u20102025\u2010under\u2010the\u2010inflation\u2010reduction\u2010act\u2010and\u2010how\u2010enrollees\u2010will\u2010benefit\/."},{"key":"e_1_2_10_32_1","unstructured":"J.CubanskiandT.Neuman What to Know About Medicare Part D Premiums KFF August 1 2024 https:\/\/www.kff.org\/medicare\/issue\u2010brief\/what\u2010to\u2010know\u2010about\u2010medicare\u2010part\u2010d\u2010premiums\/#:~:text=For%202024%2C%20the%20average%20monthly than%20in%20PDPs%20(%2443)."},{"key":"e_1_2_10_33_1","unstructured":"Technical Memorandum on the Changes to True Out\u2010of\u2010Pocket (TrOOP) Costs and the Calculation of the Maximum Monthly Cap for the Medicare Prescription Payment Plan https:\/\/www.cms.gov\/files\/document\/hpms\u2010medicare\u2010prescription\u2010payment\u2010plan\u2010troop\u2010memorandum.pdf."},{"key":"e_1_2_10_34_1","unstructured":"J.CubanskiandA.Damico Key Facts About Medicare Part D Enrollment Premiums and Cost Sharing in 2024 KFF accessed August 5 2024 https:\/\/www.kff.org\/medicare\/issue\u2010brief\/key\u2010facts\u2010about\u2010medicare\u2010part\u2010d\u2010enrollment\u2010premiums\u2010and\u2010cost\u2010sharing\u2010in\u20102024."},{"key":"e_1_2_10_35_1","unstructured":"CMS Annual Release of Part D National Average Monthly Bid Amount and Other Part C & D Bid Information; July 29 2024 https:\/\/www.cms.gov\/files\/document\/july\u201029\u20102024\u2010parts\u2010c\u2010d\u2010announcement.pdf."},{"key":"e_1_2_10_36_1","unstructured":"CMS Inflation Rebates in Medicare accessed August 3 2024 https:\/\/www.cms.gov\/inflation\u2010reduction\u2010act\u2010and\u2010medicare\/inflation\u2010rebates\u2010medicare."},{"key":"e_1_2_10_37_1","unstructured":"How CBO Estimated the Budgetary Impact of Key Prescription Drug Provisions in the 2022 Reconciliation Act February 2023 https:\/\/www.cbo.gov\/system\/files\/2023\u201002\/58850\u2010IRA\u2010Drug\u2010Provs.pdf."},{"key":"e_1_2_10_38_1","unstructured":"Congressional Research Service Medicare Part D Prescription Drug Benefit R40611 November 14 2023 https:\/\/crsreports.congress.gov\/product\/pdf\/R\/R40611."},{"key":"e_1_2_10_39_1","unstructured":"B. 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