Latest Prescription Drug Price Negotiation Draft Takes Two Steps Back for Seniors

WASHINGTON--(BUSINESS WIRE)--The Partnership to Fight Chronic Disease (PFCD) released the following statement today regarding the Prescription Drug Pricing Reform proposal aiming to lower drug prices through government negotiation under Medicare:

“More than half of U.S. adults are living with at least one chronic condition and four in ten adults live with two or more. For people with Medicare coverage, chronic disease prevalence is even higher with millions depending on medicines and needing help lowering costs and other barriers to access. Unfortunately, the latest draft of drug price legislation does less to reduce patients’ costs than earlier versions and does nothing to reduce prior authorization, step therapy, and other access hurdles in Medicare.

“Critical reforms that reduce out of pocket costs for common, chronic conditions are absent from this proposal — and in the case of caps on patient costs for insulin — removed altogether. With at least two Senate proposals already in play that could make progress in addressing insulin cost issues, this proposal is a significant downgrade from meaningful reform for people reliant on insulin and a missed opportunity to lower costs for people living with other chronic conditions. The focus should be on lowering costs for patients.

“Though the latest proposal includes a welcome Part D maximum out of pocket limit, $0 copay in the catastrophic coverage phase, and an increase in income level for people eligible for low-income subsidies, it delays the relief these changes would provide to Medicare beneficiaries until 2025 and leaves Part D coinsurance rates unchanged. The bill falls short on the out-of-pocket cost-savings for seniors promised previously and critically needed by many living with chronic diseases.

“Real help in lowering out-of-pocket costs for Medicare beneficiaries would build upon the cap on costs for insulin to include other medications for common chronic conditions. Instead, the latest bill language removes the cap on insulin costs, lessens patient protections against premium increases, and does nothing to address needed reforms directed at pharmacy benefit managers’ (PBMs) practices that drive prices, increase patient costs, and limit patient access.

“There is an opportunity to address out-of-pocket costs more directly that would advance health equity, particularly as Black and Latino people with Medicare are more likely to experience drug affordability issues. Beneficiaries with lower incomes are also particularly vulnerable and have above-average rates of not taking needed medicines due to the out-of-pocket costs they face. This proposal misses the mark with respect to improving costs, access, and overall health outcomes for Medicare beneficiaries more broadly.”