PFCD Responds on IPAY 2027 and Impacts for People Living with Chronic Disease

November 26, 2025 (WASHINGTON, D.C.) The Partnership to Fight Chronic Disease (PFCD) released the following statement in response to the Centers for Medicare and Medicaid Services’ (CMS) announcement of the “maximum fair prices” for the 15 drugs selected for Medicare price-setting in 2027 under the Inflation Reduction Act (IRA):

“Nearly 88% of U.S. adults aged 65+ rely on prescription medicines monthly, with 40% using five or more. When considering how best to improve overall health outcomes in the U.S., Medicare beneficiaries need robust access to innovative treatments. However, the IRA’s price-setting program and broader changes to Medicare Part D risk that access going forward. A recent analysis shows that in response to the IRA, Part D plans are increasing out-of-pocket expenses and formulary barriers for beneficiaries, jeopardizing access for those who need treatment most.​

“The Part D drugs selected for Initial Price Applicability Year (IPAY) 2027 reflect significant cost and coverage implications for Medicare beneficiaries. Many of these medicines are already highly rebated, with seven of the 15 chosen medications having average estimated rebates exceeding 40%. These drugs were utilized by approximately 5.3 million Part D patients between November 2023 and October 2024, accounting for an average of less than $650 a month in Medicare spending per beneficiary – before rebates – during that period. Yet changes under the IRA have led plans to charge patients coinsurance instead of fixed copays, compounding out-of-pocket burdens for patients.

“It is clear that the IRA’s price-setting approach to make drugs ‘more affordable for seniors’ will not deliver meaningful savings to patients, with insurers and pharmacy benefit managers (PBMs) merely shifting costs while continuing to profit. Instead of looking for ways to double-down on this approach, PFCD calls on policymakers to focus their attention on bipartisan solutions that protect patient access while also addressing affordability for patients themselves. This includes requiring PBMs to pass on negotiated savings to patients at the point of sale, delinking PBM compensation from the list price of medicines, prohibiting exploitative tactics like copay accumulators, and never allowing discriminatory measures such as the quality-adjust life year (QALY) to shape pricing and coverage decisions in the U.S.

“Making lower health care costs a reality for people managing one or more chronic conditions is not just a matter of price but also access to prescribed medicines that support better health outcomes. PFCD will continue to call attention to how the IRA’s price-setting is failing American seniors. Commonsense reforms that protect patient access must be a priority.”