New Prescription Drug Price Reduction Agreed on
Last week the Democratic majorities in Congress reached an agreement on new measures to begin reducing prescription drug prices. These are not as far-reaching as those proposed previously but they still are major steps forward in beginning to control drug prices.
The agreement would for the first time allow Medicare to negotiate lower prices on some drugs. But the negotiation provision was scaled back to only apply to older drugs that are no longer on their period of “exclusivity,” when they are protected from competition. That translates to nine years for many drugs and 12 years for more complex biologics.
The reporting on the agreement appears to have some discrepancies, but apparently after identifying 100 of the most expensive drugs, ten of them would be subject to negotiation starting in 2023 with the negotiated prices going into effect in 2025, and with up to 20 drugs under negotiation starting in 2028.
For seniors on Medicare, the agreement includes a new cap of $2,000 on out-of-pocket drug spending, which could save money for those who take expensive medications.
The measure would also limit drug price increases to the rate of inflation and limit the price of insulin to $35 a dose.
Eventually, Medicare will likely be able to negotiate the prices of a lot more than just 20 drugs.
That means there's no limit on the number of drugs that can be negotiated over time. Which drugs are eligible, however, is still much more restricted than the original House drug pricing proposal was.
According to Senate Finance Committee Chairman Ron Wyden (D-Ore.), “There’s going to be negotiation on the most expensive drugs: cancer drugs, arthritis drugs or the anticoagulants. And that’s a precedent, and once you set a precedent that you can actually negotiate, you are really turning an important corner.”
Although this does not do all that we had hoped for, TSCL is pleased that the agreement has been reached and we are urging members to pass the legislation as soon as possible.
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Drug Companies Fought Against any Legislation that would Force Drug Prices Lower
We are at a strange point in our society where on the one hand, drug companies are heroes for the way they developed vaccines against Covid-19 so quickly – vaccines that have saved many lives and allowed us to think about returning to normal.
One the other hand, they are villains for the way Americans are made to pay the highest prices for prescription drugs in the developed world.
Reaching the agreement to lower drug prices is a major breakthrough because the pharmaceutical companies opposed any changes to the way things are now. They have spent over $23 million in the first 9 months of this year lobbying Congress against any legislation regarding drug prices.
They deployed an army of 3 lobbyists for every 1 member of Congress. And yet this new agreement will open the door to regulate drug prices for the first time.
This happened because of pressure from the American people that was put on Congress through TSCL and other organizations like it, as well as direct pressure from voters on members of Congress
We are pleased and proud to have played a significant part in what appears to be a major victory for seniors throughout the U.S.
However, the House and Senate will not be voting on any legislation this week so we have to wait until at least next week to see if they can reach a final agreement in the House regarding the over-all bill that contains the measure to reduce prescription drug prices. Once it passes the House, it moves on to the Senate, where changes could still be made, although the agreement appears to include the Democratic majorities in both the House and the Senate.
Republicans, virtually unanimously, have decided to vote against whatever the final legislation looks like when it comes up for a vote.
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Hearing Makes it, but Dental and Vision are out
TSCL had been hoping that Medicare coverage for hearing, dental and vision services would be included in the new legislation but the agreement reached last week includes only hearing services.
According to Kaiser Health News, “The new benefits include coverage of certain hearing aids for ‘individuals diagnosed with moderately severe, severe, or profound hearing loss,’ and allows seniors enrolled in traditional Medicare to get a hearing aid for each ear every five years. The new benefits cover devices furnished after a written order from a physician, audiologist, hearing aid professional or other clinician.”
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Medicare Reimbursements to Certain Doctors to be Cut
During the Covid-19 pandemic Medicare increased payments to certain specialty doctors, including cardiologists and radiation oncologists, by 3.75 percent. That pay increase is set to expire in 2022 and Medicare has decided to allow the expiration.
As a result, several specialties, including interventional radiology, vascular surgery, radiation oncology, and cardiology will see their Medicare reimbursements decrease next year, while other specialty providers like diagnostic testing facilities, portable x-ray, podiatry, hand surgery, and geriatrics will see payment increases, according to the Centers for Medicare & Medicaid Services.
As is to be expected, doctor groups are protesting.
“These cuts will endanger patient access to cancer care,” Laura Dawson, chair of the board of directors of the American Society for Radiation Oncology, said in a statement. “Treatment facilities may be forced to cut services or close, which will exacerbate health disparities.”
And another: “Our patients put their trust in us to provide them the best care, but it’s becoming increasingly clear that they cannot trust the system that’s supposed to be set up to support them,” David B. Hoyt, executive director of the American College of Surgeons, said in a statement. “These Medicare cuts will further exacerbate our pandemic-strained health care system and cause further delay in care to the patients who need it most.”
This is something TSCL will keep an eye on. While every effort must be made to contain the costs of medical care in this country, at the same time we cannot jeopardize the care that is needed by seniors.
As we continue dealing with the Covid 19 pandemic, TSCL remains constant in our fight for you to protect your Social Security, Medicare, and Medicaid benefits. We’ve had to make some adjustments in the way we carry on our work, but we have not, and will not stop our work on your behalf.
For progress updates or for more information about these and other bills that would strengthen Social Security and Medicare programs, visit the our website at www.SeniorsLeague.org, follow TSCL on Twitter or Facebook.