A SECOND OPINION
A Second Opinion welcomes the freely written articles of our diverse membership , whether these conform to the opinions of our publishers , our Editorial Board or other groups . However , we ask that opinions remain collegial and respectful . The Editorial Board and Oversight Committee reserve the right to choose what is published . We invite you to share your thoughts with us , and to respond to others , at editor @ glms . org . Publication does not represent endorsement by Louisville Medicine or GLMS . Let us hear from you !
“
It
’ s about time , it ’ s about space , it ’ s about two people in the strangest place .” Yes , I am talking about Medicare lowering the cost of prescription drugs . Wait , don ’ t faint – give the lady in the back some air . No crowding , please . This has been in the works for a while .
The 2022 Inflation Reduction Act , a President Biden initiative , was designed to lower the cost of prescription medicines . Since 2023 , pharm giants and Medicare have been feeling their way through the first negotiations on pricing . In August , Medicare announced the first 10 drugs on the list : all brand name , all expensive and for the most part , all taken chronically , and not just here and there . Together these drugs added more than $ 50 billion – about 20 % of the total gross Part D tab – to the taxpayers ’ burden in 2022 and 2023 .
The actual cost reductions will not appear till 2026 ( no need to panic-sell that yacht , Big Pharma ). Medicare has said that the detailed cost reductions will be announced by the end of August this year .
These first drugs are Eliquis , Jardiance , Xarelto , Januvia , Farxiga , Entresto , Enbrel , Imbruvica , Stelara and two fast-acting insulins , Fiasp and Novolog pens and vials .
This is just the initial thrust . For 2027 , 15 more drugs under Part D will be selected . In 2028 , 15 drugs covered under Part B ( shots and infusions ) come under the knife , plus those for Part D . Up to 20 more drugs per year will join their ranks after that .
It ’ s About Time … by MARY BARRY , MD
Two days after Derby , the official public comment period opened up , set to close on July 2 . This is a federally regulated process ; comments must be sent electronically to the Centers for Medicare & Medicaid Services ( CMS ) with suggestions , criticism and proposed corrections setting the tone . The comments section from the summer of 2023 , when these changes were in the works , is illuminating .
People with rare diseases wrote in to plead that the specific limited-use treatments they must have should be exempt from the relentless prior authorization pyramid : “ You Gotta Fail Drugs A Through F Before We Will Even Think About It .” Often , the number of treatments for rare diseases is very small . Sometimes there is only one drug , sometimes a few . Patients live in fear that their employers will change insurers and they will suffer a period of zero treatment , while they jump through all the new hoops with the new company . Even worse , their employers could look at the cost , and simply bail : get different insurers with more restrictive plans , with the sick person scrambling to find any plan at all .
The “ Extra Help ” part of Medicare is for people with very limited finances , helping them to pay Part D premiums and out-of-pocket costs . That ’ s been a lifeline for those on disability especially , and with governmental price negotiation now a reality , our tax dollars will go farther , to help more people .
CMS also held public listening sessions : each speaker was limited to three minutes to tell the story of how prescription coverage , or lack of , had affected their lives . The transcripts are illuminating . The provision for spreading out the costs , instead of needing to front the several thousand dollars all at once in January to meet the deductible , was viewed as a huge help to the average retired person . Several speakers noted that they would no longer need to skip doses . They could sleep much better knowing that giant bills would not be draining their savings only two months into the new year .
The law ’ s new $ 2,000 annual cap for out-of-pocket prescription Medicare Part D cost will be a huge boon to those eligible . That is a far more budgetable expense , as opposed to ever-mounting bills that leave people stunned and hungry , trying to decide if they should pay the rent or buy some groceries . In March 2023 , Jesse Bedayn of the Associated Press estimated that 100 million Americans collectively owed nearly $ 200 billion to doctors , hospitals , nursing
32 LOUISVILLE MEDICINE OPINION