AARP

[Woody1542]

 I just finished a phone call with AARP. I was asking why AARP is not pushing for the cap on inhalers to be available to seniors on Medicare. No answer except I should contact United Healthcare. I though AARP was independent of insurance companies and were fighting for seniors. Maybe not. 

[GailL1]

Medicare.gov- 2025 Savings in Medicare Part D 

Government is working on it - some changes take place in 2025 and then others are added in the following years.

To add a bit more as to how the prices of many drugs may be reduced (and not just a limit to patient copays) is the stipulation in the Inflation Reduction Act that penalizes drug companies for price increases on older products higher than the rate of inflation.

ROLLCALL 03/26/2024- Policy Experts Say Medicaid Rebate Change is Behind Inhaler Price Cut 

It is impossible to compare this reduction in price in the private marketplace to that of Medicare and Medicaid because private health care coverage doesn’t have laws that dictate what government pays since government doesn’t pay at all.

Between you and your Part D and Part B drugs, if you are on Medicare and/or Medicaid is a mountain of government rules that have to be changed by law that are keeping the government’s share of the price down - 

Complicated - yep - but that’s government involvement.  

[Woody1542]

 I realize things like negotiating prices for certain drugs. I thank President Biden for this. That does not answer my question why AARP is not fighting for the changes in inhaler prices to be available to ALL. Not just uninsured and no insurances. We have insurance. I have a Part D, independent supplier. I pay them separately from Medicare. They should be accepting the $35 dollar cap. Also, as I said, why is AARP not fighting for this already?

[GailL1]

What you pay under your choice of Part D plans isn’t ALL that the manufacturer is getting paid under Medicare.  

It is just like the Insulin reduction - private insurers didn’t get this insulin reduction automatically- 

PBS 01/25/2024 - New law caps insulin prices for some with diabetes, but cost remains high for other...

There are a lot of players in the drug pricing scheme - and for Medicare/Medicaid there are laws that have to be changed because the government is involved in the pricing as well as the insurers and the PBMs -

For Medicare, the IRA is a beginning IF it works out as planned - but it will not happen overnight.  It is what we have at the moment - but when one goes on Medicare then you are ordered to get a Part D plan of your. choice or be penalized with a life long penalty.  When a beneficiary does that, they are then playing by different rules than private coverage cause the government is involved as part of the payer.

What would happen if the government got out of the Medicare Prescription Drug program - Wouldn’t the drug companies have to make sure that this huge number of drug users bought their product?  Would they lower their prices to accommodate?  Maybe - but then there is that huge number of poor beneficiaries that somebody has to help pay for - 

Came back to add:

KFF.org 10/23/2023 - An Overview of how Medicare Part D works 

[Woody1542]

 I am not looking for an argument. I realize there is a ton of government red tape. What I am saying is the squeaky wheel gets the grease and more people, like AARP and others need to start making some noise and it will get done. They managed to do it with insulin, as you and I both mentioned. Here is the article on the inhalers. Seems like the blueprint is already in place after the afore mentioned insulin price caps. I am just looking for AARP to start pushing or nothing ever gets done. 

These Inhalers No Longer Cost More Than $35 Per Month (verywellhealth.com)

[GailL1]

@Woody1542 

To add a bit more - In the News today:

Stateline 07/16/2024 - Angry patients spur new state watchdogs to bring down drug prices 

[GailL1]

@Woody1542 

Whois arguing?  I am only trying to explain how the program of Part D works and the (legal) steps to change the Part D program that have to be completed to get it done and it all take time.

I understand your complaint about inhaler cost in the Part D program.  The 2025 out of pocket cap in the Part D program will help a lot.  That’s already in place to begin January 01, 2025.  

Then there is the drug negotiations that are taking place in the next few years for both Part D and Part B drugs - 

I don’t know the priority of all drugs but I am sure they looked at how many are taking a particular one — like insulin.  Then for others, like the ones that are currently being negotiated and the ones in the next few years when the process speeds up - those were picked because they cost the government so much as well as the beneficiary.  

Then as I pointed out - the insulin $35 cap is ONLY applicable to Medicare beneficiaries currently.  Those with private insurance or NO insurance didn’t get this cap - they have to apply for help based on their income to get a break on a case by case basis.  

If your income is low enough,  you can get the inhaler medication pretty much free or very low cost as a Medicare beneficiary.  

Yes, it would be a whole lot simpler if there was just one payer.  It starts getting complicated in who or which entity pays how much. 

Each level of insurance is different - and I don’t believe that our government wants to overload the changes currently in place so that they can make sure that it is working as they have planned and so premiums don’t rise for all the beneficiaries in the whole system - well, at least for the ones that do pay a premium and part of their drug cost.  

So all I am saying is that change takes time and change has already started with the passing of the Inflation Reduction Act.  So not arguing, just pointing out the realities.  

[Woody1542]

 Sorry I took it the wrong way. I do have a reporter from The Lever working on this and also a couple members of the Ohio House looking into it next session. I just think since the blueprint was set up for the insulin cap it should be mostly set up for the asthma inhalers already. I am hoping for the Xarelto cap next year as my wife takes that and the price is BS. Thanks for the informative articles. Again, sorry for the misunderstanding. 

[GailL1]

@Woody1542 

Xarelto is currently being negotiated - it is on the (10) current list - results are suppose to be out in August or September 2024 - but these don’t take effect until January 2026.  

But don’t get too comfortable, last I read some the drug manufacturers were going to court to stop this on some of the drugs.

Remember it is imperative to get this right because if the med isn’t priced where the manufacturer can still make money from it, then they may slow the production of it.  So a very tender and important balancing act of numbers - that should be fair and equitable all around. 

American Progress.org - 02/21/2024- Medicare Drug Price Negotiation Will Lower Prices by Thousands o...

From the link ~

The Inflation Reduction Act of 2022 enabled Medicare to negotiate prices for prescription drugs for the first time in the program’s history. In August 2023, Medicare announced the first 10 Medicare Part D drugs selected for negotiation. The U.S. Centers for Medicare and Medicaid Services submitted its initial offerfor negotiated prices in February 2024, and the negotiated prices will be finalized and published in September 2024. The negotiated prices will take effect in January 2026. These 10 drugs are among those with the highest annual Medicare Part D spending, indicating very high prices and/or very high utilization rates. Given limited transparency in drug pricing, it is often difficult to estimate drug costs, especially because net prices, which are often unknown, differ from list prices and vary among payers.[end copy paste]

KFF.org 01/31/2024 - 3 Charts: Medicare Drug Price Negotiations

You see - it is complicated.  But the $ 2000 out of pocket cost cap (per beneficiary) in 2025 will probably help you and your wife’s drug cost.  This rule and how it will work along with all other Part D changes has yet to be finalized and can’t be announced until October 1, 2024.  

CMS.gov- Fact Sheet: Medicare Drug Price Negotiation Program Draft Guidance for 2027 and Manufacture...
the Maximum Fair Price in 2026 and 2027