Timely Findings Highlight Increased US Physician Familiarity with IRA Changes Amid Ongoing Reimbursement and Education Concerns, According to Spherix Global Insights

Recently released research reveals key insights into physician perspectives, practice management changes, and expected prescribing changes resulting from recent IRA-driven Medicare changes.

/EIN News/ -- EXTON, PA, April 10, 2025 (GLOBE NEWSWIRE) -- In 2025, the Inflation Reduction Act (IRA) introduced significant Medicare reforms designed to reduce financial burdens for patients, including a new cap on out-of-pocket (OOP) prescription drug costs, the elimination of the Medicare Part D coverage gap known as the "donut hole," and the smoothing of medication payments over the calendar year. These changes aim to make healthcare costs more predictable and manageable for seniors, enhancing overall medication affordability and adherence.1 

Spherix Global Insights recently released study: Special Topix™: The Impact of the Inflation Reduction Act (IRA) on Specialty Practices in 2025 – Wave II, reveals key insights into physician perspectives and practice management dynamics resulting from the IRA-driven changes. 

Fielded in March 2025, the study engaged 311 specialists, including dermatologists, gastroenterologists, rheumatologists, nephrologists, neurologists, and ophthalmologists, to assess awareness, familiarity, and projected impact of IRA policies on clinical practices. Notably, the report includes insights on unmet needs in physician, staff and patient education on these changes and desired support to help better navigate prescribing. 

In the research, specialists reported greater familiarity with the IRA’s core elements compared to late 2024, particularly the Medicare OOP cost cap and the elimination of the Part D "donut hole." Physicians across specialties, notably rheumatologists, indicated that while initial short-term impacts appeared lower than expected, they anticipate greater long-term implications from these IRA provisions. 

Despite positive attitudes toward the IRA’s potential to enhance medication affordability for seniors, physicians expressed notable concerns regarding reimbursement, especially related to telehealth fee schedules and "buy-and-bill" products. Indeed, the survey found physicians divided over anticipated challenges in obtaining reimbursement for these products, reflecting broader uncertainty within specialty practices. 

Medicare patients' OOP costs remain a significant factor influencing prescribing decisions, with specialists consistently agreeing that lower OOP expenses would positively affect patient adherence and outcomes. Nonetheless, patient awareness about these specific IRA changes remains relatively limited, with only 15-20% of Medicare patients actively inquiring about the updates. Rheumatologists and neurologists reported the highest patient inquiries. 

Compounding these patient education challenges, the responsibility for educating patients on IRA-related changes has not yet become clearer in Q1 2025. Practices increasingly rely on office reimbursement managers as primary information sources for patients, emphasizing a critical need for additional educational materials, particularly concerning Medicare drug benefit structures and patient-specific OOP costs.

"Physicians want more clarity and support to help patients navigate these substantial policy shifts," notes Bob Shrewbrooks, Spherix Franchise Head of Ophthalmology and Neurology. "While there's cautious optimism about improved affordability, significant confusion remains regarding practical implementation and patient communication."

As part of ongoing efforts to support the industry through these transformative changes, Spherix team members Tucker Hurtado and Bob Shewbrooks will be attending the Asembia Specialty Pharmacy Summit later this month in Las Vegas, Nevada. They look forward to engaging with clients and stakeholders to discuss key findings from this research and share perspectives on how the IRA is shaping the specialty landscape.  
1Source: https://www.cms.gov/inflation-reduction-act-and-medicare 

Special Topix™ is an independent service that includes access to a report or series of reports based on current events or topics of interest in specialty markets covered by Spherix.

About Spherix Global Insights  

Spherix is a leading independent market intelligence and advisory firm that delivers commercial value to the global life sciences industry, across the brand lifecycle. 

The seasoned team of Spherix experts provides an unbiased and holistic view of the landscape within rapidly evolving specialty markets, including dermatology, gastroenterology, rheumatology, nephrology, neurology, ophthalmology, and hematology. Spherix clients stay ahead of the curve with the perspective of the extensive Spherix Physician Community. 

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NOTICE: All company, brand or product names in this press release are trademarks of their respective holders. The findings and opinions expressed within are based on Spherix Global Insight’s analysis and do not imply a relationship with or endorsement of the companies or brands mentioned in this press release.

Bob Shewbrooks, Franchise Head
                    Spherix Global Insights
                    4848794284
                    bob.shewbrooks@spherixglobalinsights.com