Politics Congress to act on drug price reform Here's...

Congress to act on drug price reform Here’s what you need to know

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Demonstrators outside PHRMA headquarters in Washington, DC, protested drug companies lobbying to prevent Medicare from negotiating lower drug prices.

Saul Loeb/AFP via Getty Images


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Saul Loeb/AFP via Getty Images


Demonstrators outside PHRMA headquarters in Washington, DC, protested drug companies lobbying to prevent Medicare from negotiating lower drug prices.

Saul Loeb/AFP via Getty Images

American Pay more than people in other countries do for prescription drugs. It drives voters crazy, and even though lawmakers have been promising to do something about it for decades, they haven’t made much progress.

That could change as soon as this week. The Inflation Act – Senate Majority Leader Chuck Schumer, DN.Y. and Senator Joe Manchin, DW.V. hashed out. – Includes many Provisions around drug pricing and health insurance. The Senate plans to bring the bill up for a vote on Saturday, and it looks likely to pass through Congress and be signed into law by President Biden.

All this is music to the ears of patients who have been burdened with years of high-cost drugs.

“The proposal to limit out-of-pocket costs that is currently on the table would certainly make a huge difference in my life,” says Bob Parent, 69, a Medicare recipient from Westbury, New York. He has type 1 diabetes and pays $5,000 out of pocket each year for insulin, thousands more for heart medication.

Here are details about that proposal and other details of the bill and answers to some frequently asked questions.

What exactly is Congress changing about drug prices?

For the first time, the federal health secretary will be able to directly negotiate the prices of some expensive drugs for Medicare each year. It starts with 10 drugs in 2026 and increases to 20 drugs by 2029. To be eligible for negotiation, drugs must have been on the market for several years.

Then there’s the proposal Parent is excited about: People on Medicare would have to pay no more than $2,000 a year for prescription drugs, which would make a big difference for seniors with certain conditions like cancer and multiples. Sclerosis will begin in 2025.

And, starting next year, if drug companies raise their drug prices faster than inflation, they will have to give Medicare a rebate. It can affect many drugs – according to an analysis by the Kaiser Family Foundation; In 2019-20, Half of all prescriptions Costs covered by Medicare rose faster than inflation. This provision may help discourage drug companies from continuously raising prices.

Do experts think it will make a difference?

In fact, many health policy experts believe these changes are significant.

“It’s a big breakthrough,” he says Tricia Newman, who directs the Program on Medicare Policy at KFF. “Congress has been talking about doing something about drug prices for decades. [This] It may not be everything everyone wants, but it’s a really big deal and will provide significant help to literally millions of people who need it.”

“It’s a big deal,” agreed Stacey Dusetzina, professor of health policy at Vanderbilt University. “It really breaks a lot of new ground and solves a lot of problems.”

Congressional Budget Office, J An earlier version of the bill was analyzedThe changes are estimated to save the government $288 billion by 2031.

Why does it take so long for many of these things to start?

For someone on Medicare and spending $10,000 a year on cancer treatment, like Newman’s friend, the timeline of these changes can be hard to take.

“Obviously, she’s going to wonder next year, ‘Why am I still paying so much?'” Newman says. “Some things can’t happen fast because things take a while to accelerate.” Federal health agencies and industry groups will have a lot of work to do to get ready to implement these provisions.

Newman says she understands people are eager for relief, but once provisions like the out-of-pocket cap in Medicare go into effect, “it’s going to be a really big deal for people who rely on expensive drugs and others who see their medicine. Prices go up every year.”

I have heard that this bill will reduce new drugs. Is that true?

This is an argument made by drug makers to scare people into opposing these changes. The pharmaceutical and health products industry spent more on congressional lobbying in 2022 than any other industry, According to the nonprofit Open Secrets. is fighting hard to prevent these changes from becoming law because they will cut into their profits.

For example, PhRMA, the Pharmaceutical Research and Manufacturers of America, Presenting your role in the advertising campaign The bill’s drug pricing provisions could “chill research and development” and lead to fewer new drugs coming to market. The trade association pointed NPR to this industry-sponsored analysis from to swallowThe bill is estimated to cut $450 billion in drug manufacturers’ revenue by 2032.

But a Analysis by the Congressional Budget Office The impact on drug development is expected to be modest. About 15 of the 1,300 drugs won’t be on the market in the next 30 years—that’s about 1% of new drugs. Also, most of the big pharmaceutical companies Spend more on marketing than research and development.

Some ads claim that Medicare will be cut. Is this true?

These advertisements are misleading. For example, a dubbed project Commitment to superiors Launched a seven-figure ad campaign claiming the Senate bill would “eliminate nearly $300 billion from Medicare.” In fact, the government is expected to save that much money because Medicare won’t have to pay as much for expensive drugs, money that isn’t taken out of the Medicare budget. Therefore, the important thing is that there will be no reduction in the benefits of senior citizens.

“When people see an ad on TV called Commitment to Seniors, it seems pretty innocuous,” says Michael Beckel Off issue one that tracks dark money. It turns out, Commitment to Seniors is a project of another group, American Commitment, that PhRMA has awarded more than a million dollarsWith this $325,000 in 2020.

Beckel says it’s not uncommon to see industries engage in such tactics. “The pharmaceutical industry is a major lobbying force and a major dark money player.”

What about insulin? Will people with diabetes get help at those prices?

When it comes down to it, insulin is often the poster-child drug Prices out of control and life-and-death claims. US insulin prices are Four times more After discounts, on average, compared to other countries, and approx 1 in 4 diabetics They reported taking less insulin than prescribed because they could not afford it. At this point, it’s unclear whether any of the proposed reforms to insulin pricing — or at least out-of-pocket costs to patients — will make it into the final bill.

provision of Copies cap at $35 per month There is bipartisan support for people with insurance who take insulin, but may not be included in the final bill.

What else is in the health bill?

Another big thing in the bill is protecting consumers from the potentially devastating change that would happen without the new law.

People who buy insurance on the Affordable Care Act Marketplace—eg Healthcare.gov And state markets – will be able to keep generous premium subsidies for another three years. After these additional subsidies went into effect after the passage of the American Rescue Plan, the government estimated that 4 out of 5 enrollees would be eligible for a plan with premiums of $10 or less per month.

Kritika AminJ, who works with Neuman at KFF, says it’s important for lawmakers to slow the expansion now, as insurers are currently setting their rates for next year’s plans before open enrollment in the fall.

“If Congress is able to extend additional subsidies before the August recess, it will help provide certainty to both insurers and state and federal agencies that are operating. [the marketplaces] To be able to implement that seamlessly for customers,” she says.

Additional discounts on the plans have made the difference. Last year 14.5 million people – more than usual – signed up for insurance on Healthcare.gov, and preliminary analysis from HHS indicates the total number of uninsured people in the US Hit a record low In the first months of this year.

NPR Pharmaceuticals Correspondent Sidney Lupkin contributed to the report.

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