Oliver Wyman December 12, 2024
Lindsay Knable, Sarah Snider, Brooks Conway, Steven Armstrong, and Katherine Petty

Insurers have had to adjust their drug coverage strategies in response to the IRA and other market headwinds.

The Inflation Reduction Act expands the share of costs Medicare Advantage Prescription Drug (MAPD) plans and standalone Prescription Drug Plans (PDPs) will be expected to cover starting in 2025. Carriers are adjusting their formularies in response to this, as well as other mounting headwinds. Decisions around formulary design are a key factor in Part D plan success as they impact member cost sharing and utilization, access to therapies, manufacturer rebates, and member plan selection.

Our analysis of 2025 MAPD formulary strategies identified several emerging trends. Specifically, formularies for the large national carriers appear to have remained stable compared to those of many...

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Topics: Biotechnology, CMS, Congress / White House, Govt Agencies, Insurance, Medicare Advantage, Pharma, Pharma / Biotech
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