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Projected Savings From Out-Of-Pocket Cap
Asthma and chronic obstructive pulmonary disease (COPD) disproportionately affects Black, Latino, and Native American communities, as a result of key social determinants of health – such as air pollution, limited access to care, and economic inequities. For many living with asthma, annual prescription drug costs can average up to $1,830 per person, forcing patients to choose between adhering to their treatment plans and affording other basic life necessities. In general, 30 percent of Black people and 42 percent of Latinos in the U.S. report not taking prescribed medication due to cost – driving higher rates of hospitalization and mortality for these communities. There is encouraging news however for some patients on Medicare with asthma and COPD who could see relief in January when the annual $2,000 out-of-pocket cap goes into effect. A new analysis published in the Journal of General Internal Medicine estimates that 360,000 patients on Medicare with asthma and/or COPD could save more than $1,000 per year, with total out-of-pocket savings exceeding half a billion dollars annually, helping to ease the financial burden that contributes to medication nonadherence and worse health outcomes. — (Asthma and Allergy Foundation of America, KFF, Politico, Journal of General Internal Medicine)
Rising Prices Of Cancer Therapies
Big Pharma’s exorbitantly high launch prices and consistent price gouging of cancer medications have reached unsustainable levels at the expense of patients. A new study in Nature reveals the staggering scale of this issue: in 2023, the U.S. spent $99 billion on cancer therapies, with projections soaring to $180 billion by 2028. Why is that? This surge is driven by two alarming trends: new cancer therapies are coming to market at astronomical prices, often exceeding $100,000 per treatment, and existing drugs are seeing perpetual price hikes that outpace the rate of inflation. And the consequences are dire for patients. The study highlights that 50 percent of older adults skip filling prescriptions for cancer therapy when their out-of-pocket expenses exceed $2,000. However, for cancer patients on Medicare, in 2025, the $2,000 cap on out-of-pocket costs mandated in the IRA is projected to save patients an average of $7,590 annually, with some patients saving up to $19,296. The Inflation Reduction Act, alongside critical reforms to our patent system, offer hope for more affordable cancer treatments in the future. — (Nature, P4AD, patientspushforcompetition.org)
P4AD Advocates Celebrate Relief At HHS Roundtable
From lower insulin costs to free vaccines, patients on Medicare are seeing benefits that will only continue to grow as the law is fully implemented. This was the theme of a virtual roundtable this week which included patient advocates, Department of Health and Human Services (HHS) Secretary Xavier Becerra, and Centers for Medicare & Medicaid (CMS) Director Dr. Meena Seshamani. P4AD founder and cancer patient David Mitchell shared how the cap on out-of-pocket costs has already saved him more than $13,000 this year. “The IRA is delivering lower prices, lower out-of-pocket costs, steady or lower premiums and all the while maintaining a strong innovation pipeline,” shared David at the virtual roundtable. “It’s a big win for me and millions of other patients like me.” Lisa McRipley, a patient advocate who lives with multiple sclerosis (MS), expressed the relief she felt knowing that next year, the annual out-of-pocket cap will save her up to $6,000. Patient advocates played a critical role in the passage of the IRA in 2022 and remain on the frontlines of ensuring its successful implementation, and educating the public on the historic drug prices reforms.
ICYMI
CMS unveiled a preliminary list of 101 generic prescription drugs for which the agency expects to cap monthly prices at $2. The drug list, which is part of a voluntary model proposal, includes common drugs for cholesterol, high blood pressure, and other chronic conditions. Serving as a companion to the drug price reforms in the IRA, this initiative would stabilize prices of widely-used generic medicines, curb rationing, and increase medication adherence.
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