Lower Costs, Fewer Options? How Medicare Overhaul Is Shifting MS Drug Coverage

Newswise — The Inflation Reduction Act (IRA) is already reshaping Medicare drug coverage for multiple sclerosis (MS), but new research in JAMA Health Forum finds this shift may come with tradeoffs for patient access.

Prior to 2025, many Medicare Part D plans covered brand-name MS drugs even when generics were available, likely reflecting the influence of large manufacturer rebates and skewed incentives under Part D. However, after implementation of the IRA, many plans sharply reduced coverage of brand-name MS drugs, while generics reached near-universal coverage. At the same time, many brand-only drugs without either a generic or in-class alternative are now covered by fewer than 25 percent of plans.

For policymakers, this is early evidence the law is steering plans toward lower-cost drugs but may also be narrowing formularies in ways that could lead to reduced access and negative clinical outcomes for MS patients. For Medicare beneficiaries, lower out-of-pocket costs may come with fewer covered treatment options, depending on the drug.

Please contact Eric Horvath, Associate News Director with Penn Medicine at eric.horvath@pennmedicine.upenn.edu, to speak with the authors. They can speak to early real-world effects of IRA drug pricing reforms, implications for Medicare spending and plan incentives and what to watch next for specialty drug coverage.