Pharmacy & IRA

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​​​​​​​​​This page provides easy access to Pharmacy and formulary-related communications for providers – including policy updates, information on biosimilars, news on Medicare Part D changes resulting from the Inflation Reduction Act (IRA), and other communications.

Content is divided into three sections: IRA / Medicare Part D Changes, All about Biosimilars, and Other Pharmacy News.

Featured item: The Inflation Reduction Act

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IRA / Medicare Part D changes

The Centers for Medicare & Medicaid Services (CMS) has made significant changes for 2025, including implementing components of the Inflation Reduction Act (IRA) that will impact Medicare beneficiaries. This dedicated section provides information and resources to help providers navigate these changes.

Articles

• Medicare Part D: Providing alternatives to the top five impacted drugs, moving to Non-Formulary effective January 1, 2025 (January 9, 202​​5)
  
• IBX will offer new Medicare Advantage plans and benefits in 2025​ (January 3, 202​​5)
  
• What every clinical practice should know about the Inflation Reduction Act (December 20, 2024​​)
  
• ​ What providers need to know about formulary tier changes effective January 1, 2025 (December 2, 2024)
• Encourage your patients to use preferred pharmacies to save money on prescriptions (October 8, 2024)
• Inflation Reduction Act and Medicare Part D Changes: What providers should know (September 27, 2024)
  

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Resources

• The IRA & Medicare Part D Changes FAQ
  
• Explain IRA
  
• Find a drug
• Find a preferred pharmacy
  
• Preferred pharmacy flyer​
  

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Biosimilars

In November, Independence Blue Cross (IBX) will be announcing changes to the preferred status for Humira® and several of its biosimilars. This section is intended to provide information and awareness about biosimilars for health care professionals across our network.

Articles​​​​

• New prescriptions required for patients on Humira® (adalimumab) or adalimumab biosimilars (January 3, 2025)
  
• Effective January 1, 2025, IBX is removing Humira® (adalimumab) from its Value, Select, and Premium formularies and switching to a biosimilar (November 12, 2024)
  
• Changes to preferred products and precertification requirements for infliximab intravenous (IV) products (October 1, 2024)
  
• Changes to preferred products and precertification requirements for vascular endothelial growth factor (VEGF) products (October 1, 2024)
• Biosimilars: An opportunity to reduce prescription costs for patients (September 27, 2024)

FDA Resources

What is a biosimilar? (PDF) Nine things to know about biosimilars FDA: An Overview of biosimilar products (PDF)

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News

This list showcases recently published notifications and updates about Pharmacy policy, formulary changes, and other news.

• Pharmacy under the Medical Benefit guidelines (Dec​ember 30, 2024)
• Changes coming to weight loss drug coverage benefits, effective January 1, 2025​ (November 1, 2024)
• Changes to the Most Cost-Effective Setting Program (November 1, 2024)
• Upcoming changes to the list of specialty drugs that will require precertification (November 1, 2024)
• Changes to preferred products and precertification requirements for Intravenous (IV) Iron (October 1, 2024)
• Upcoming drug formulary updates (September 25, 2024)
• Updates to the Direct Ship Drug Program (August 22, 2024)
• Upcoming: Updates to the medical benefit specialty drug cost-share list (June 5, 2024)
• Changes to the Most Cost-Effective Setting Program (June 3, 2024)
• Premium Formulary drug program changes (May 7, 2024)
• Upcoming changes to the list of specialty drugs that will require precertification (April 30, 2024)
• Changes to the Dosage and Frequency Program (March 21, 2024)
• Independence drug formulary updates (March 14, 2024)

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