Sweeping federal law will lower prescription drug costs for Medicare recipients

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Sweeping federal law will lower prescription drug costs for Medicare recipients


When Brenda Dickason switched from private insurance to Medicare
shortly after turning 65, she was shocked at how much more she had to
pay for the EpiPens she keeps on hand because of her severe bee allergy.

“When I got my EpiPen on regular insurance, it was $40 for two. When I
went to get it last year on Medicare, it was over $300,” said Dickason,
a retired Tucson police detective and former middle school science
teacher who sells specialty soaps and seasonal wreaths at craft shows
for extra income.

Dickason said her booth is often swarming with bees because of the scent. She also has to manage her asthma and a latex allergy.

“The season is starting, and I work to pay my Medicare and my
insurance,” she said. “So I have to make a choice: Do I go without the
EpiPen, or do I buy supplies I need for my job?”

Under the Inflation Reduction Act,
Dickason and millions of other Americans will no longer have to shell
out thousands of dollars to pay for prescription medications through
Medicare, the federal health insurance program for those 65 or older and
people with disabilities.

The sweeping measure, signed by President Joe Biden in August,
includes several provisions aimed at reducing the cost of prescription
drugs for the 64 million Americans on Medicare.

In addition to cutting drug costs, the act extends tax credits to
those insured under the Affordable Care Act – preventing an estimated 2 million people nationally and 41,000 Arizonans from losing coverage and ensuring others avoid premium increases.

“What the (inflation) act will do is improve affordability for
Americans who purchase coverage from the health insurance marketplaces
across the board by improving the amount of tax credits that those folks
are eligible for,” said Christina Cousart, senior policy associate at
the National Academy for State Health Policy.

“Eleven million individuals are now enrolled in marketplace coverage,
largely because of these affordability provisions, and that will be
maintained because of this” law.

Experts call the new law one of the most significant steps toward
improving health care in the country since the 2010 passage of the ACA,
then-President Barack Obama’s signature policy.

“The changes to the U.S. health care system in the Inflation
Reduction Act are momentous, politically and for the many patients
struggling with drug costs,” Larry Levitt, executive vice president for
health policy at Kaiser Family Foundation, wrote in The New York Times.

One big change allows the federal government to begin negotiating
drug prices directly with manufacturers of 10 drugs starting in 2026 and
10 more drugs by 2029. That’s expected to reduce government spending by
about $100 billion over 10 years, according to estimates from the Congressional Budget Office.

“That’s huge savings to Medicare beneficiaries, as well as the
Medicare program,” said Dana Kennedy, the state director of AARP
Arizona.

Many provisions of the new law affect only those enrolled in Medicare
and, specifically, Medicare Part D, which covers prescription drugs.
About 1.3 million people in Arizona are enrolled in Medicare, with just
over 1 million in Medicare Part D, federal data show.

Medicare enrollees who have diabetes or require vaccines will be the
first to reap the benefits of the new policies. Starting in 2023,
Medicare beneficiaries will pay no more than $35 a month for insulin –
for which prices have soared in recent years.

And although influenza vaccines are always free under Medicare, other
shots, including the shingles vaccine, often require copays. Under the
new law, Kennedy said, “vaccines will also be free for Medicare
beneficiaries.”

Kennedy recalled hearing from one woman recently who was quoted $400
for a shingles vaccine. “She actually got shingles because she couldn’t
afford” the shot, she said.

Starting in 2025, Medicare Part D enrollees also will see a new
$2,000 cap on annual out-of-pocket spending for drugs. That will save a
lot of money for people with conditions that require expensive
prescriptions. For example, Medicare enrollees using the cancer drug
Revlimid spent nearly $9,000 out of pocket in 2019, according to a Kaiser Family Foundation analysis.

Another provision will penalize drug companies if prices for drugs
covered under Medicare rise faster than the rate of inflation. Sarah
Bourland, legislative director for the advocacy group Patients for
Affordable Drugs, said that could help all Americans by incentivizing
drug manufacturers to keep prices in check.

“The monetary penalties paid by drug manufacturers that hike their
prices are based on Medicare sales and paid back to the Medicare
program,” Bourland said in an email. “But this does not mean Medicare
beneficiaries will be the only ones that benefit or that prices will
rise in other sectors. That’s because the penalties are based on
market-wide measures of prices. This should discourage drug companies
from hiking prices in the private sector as well.

“Commercial payers are not helpless here,” Bourland added. “They have
a tremendous amount of market power to push back on potential price
increases.”

Federal research shows that Americans pay two to three times more for prescription drugs than people in other countries.

For Dickason, those increased costs have been hard to manage.

She had to utilize coupons through GoodRx to get her EpiPens, an
injection device that delivers epinephrine to counter life-threatening
allergic reactions. That cut the cost to about $150. But Dickason also
uses an inhaler because of severe asthma and needs Botox injections to
help alleviate chronic migraines. Botox alone can cost $800.

Although it will take time for some of the law’s cost-saving
provisions to go into effect, Dickason is hopeful that once they do,
she’ll have more money to spend on other necessities.

“It’s actually more than just income,” she said. “It’s paying your bills or getting food. Those aren’t cheap.”





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