At the Advocates for Responsible Care (ARxC) and its health access project, Rx in Reach GA Coalition (Rx in Reach), we are committed to finding ways to reduce drug prices to help improve access and affordability to prescription drugs in Medicare Part D and commercial drug plans. With an increasing Medicare population and more adults and children needing vital medications to manage their serious chronic illnesses, the need to collaborate with industry, patient advocates and policymakers to reduce drug costs can only help to reduce high cost medical events while producing better health outcomes.
ARxC helped to roll-out Medicare Part D in Georgia. Medicare Part D is a highly successful program with 90% of seniors happy with it and premiums have remained lower than anticipated. One good change being proposed is an Out-of-pocket (OOP) cap for seniors; and this would be welcomed. It would set the out of pocket limit at about the same limit as when the catastrophic coverage kicks in (at about $2700).
However, we are alarmed by the dangerous changes The Senate Finance Committee is considering to the program:
- Inflation penalty, which would jeopardize access to many from children to seniors. This penalty kicks in if the list price of a drug increases more than inflation. There is also a penalty that the manufacturer has to pay back to government. In theory, this sounds fine until you read the details. The penalty:
- removes market based approach that’s made Part D so successful
- is based on list price (not accurate price of what drug actually costs)
- The list price changes, but net price has remained steady over the years
- It can change month to month, just like inflation rate, so for planning purposes; it’s hard to determine if patients are going to face the penalty.
- Hurts patients by denying access to life-saving medications. It gives big insurance more power to negotiate drug prices. ARxC and their health access project, Rx in Reach GA worked to get Step Therapy Reform passed in Georgia. These dangerous changes to Part D would mean even if a doctor prescribes a specific medication, patients will be required to spend time experimenting with medications that are less effective before and if, they would be allowed to get coverage for the more expensive vital drugs they need.
- Further injures patients by not reducing their out-of-pocket costs.
- Denies Medicare the ability to negotiate lower drug prices and allows insurance companies to deny coverage for essential medications.
The real winners in this plan are the insurance companies, and as patient advocates we feel strongly the insurance companies don’t need another win at the expense of seniors and Americans who need access to affordable drugs and care.
We implore the Senate Finance Committee to only make changes to Part D that will benefit patients like the out-of-pocket cap and reject changes that will hurt patient access like the inflation penalty and ‘step therapy’ like protocols.