One Down - One to Go

One Down – One to Go

Finally-- last week the House of Representatives passed the legislation containing measures to lower prescription drug prices and cover hearing services under Medicare. The vote was close, with one Democrat and all Republicans voting against the legislation, siding with the drug companies in arguing that the bill would result in fewer new medications being developed.

The plan would allow Medicare to negotiate some drug prices, penalize drug makers that hike prices faster than inflation, and cap drug costs for seniors and patients who use insulin.

Specifically, it would place a $35-per-month limit on the cost of insulin under Medicare and a cap on out-of-pocket prescription drug costs at $2,000 per year.

The bill would also require drugmakers to pay back profits from raising the cost of medicines above inflation.

However, the bill is not as sweeping as earlier versions and it will be a while before its provisions would go into effect if it passes the Senate.

The details of the bill are important because although it would eventually lead to lower prices on some drugs, the number of drugs affect is limited, and it would take a few years to fully implement the new law.

Here is some of what the legislation that passed the House last week would cover.

It would direct the Health and Human Services Department (HHS) to establish a “Drug Price Negotiation Program” to negotiate a maximum price of high-cost prescription drugs for Medicare Parts D and B beginning 2025.

The measure would require HHS to identify 100 drugs without competition that have been on the market for seven years and biologics that have been on the market for 11 years, and that have the highest spending under Medicare. HHS would select as many as 10 drugs from that list for negotiation in 2025 and as many as 20 drugs by 2028, plus insulin.

There are other more complicated restrictions on what drugs would be affected and when the law would take effect, but the above information probably is enough to know for now.

Although this legislation is far less than what TSCL wanted, it is a major step forward because it’s the first time legislation to try and bring the prices of prescription drugs down has been able to pass either house of Congress.

PhRMA, the brand-drug lobby, claimed the package “threatens innovation and makes a broken health care system even worse,” but the Congressional Budget Office (CBO) estimated that Democrats’ drug pricing reforms would result in ten fewer drugs entering the market over the next three decades — and only one fewer drug in the first ten years — out of an expected 1,300 new drugs.


Boost for Home Health Care

The House bill would provide $150 billion under Medicaid to enable states to give more elderly and disabled Americans the opportunity to get long-term care at home as well as to boost pay for home care workers.


Hearing Services Covered Under Medicare

If the bill passes the Senate, for the first time Medicare would cover hearing services for seniors, including coverage for a new hearing aid every five years. Coverage for dental and vision services had to be removed from the bill in order for it to pass the House. However, Senator Bernie Sanders (I-Vt) has said he still wants dental and vision benefits to be added back.