Inflation Reduction Act prescription drug benefit changes: Impact on plans and providers

As part of the Inflation Reduction Act (IRA) prescription drug benefit redesign, health plans will be encumbered with significantly higher liabilities than before. The Centers for Medicare and Medicaid Services (CMS) partially funds the Part D program through subsidies to health plans, which are risk adjusted to reflect patient health status and risk profile using the prescription drug hierarchical condition categories (RxHCC) model. The 2025 Final Notice included changes and recalibrations to the model to better account for the changes in the IRA.

Health plans will seek to offset some of these headwinds by better representing patient health status through RxHCC risk adjustment coding, placing even greater importance coding accuracy. Download Navina's guide to these changes and how to prepare for them today.