Welcome to the Week in Review.

US v. Pharma

Patients For Affordable Drugs filed a patient-focused amicus brief in the Second Circuit Court of Appeals, opposing Boehringer Ingelheim’s lawsuit to block Medicare negotiation. The amicus brief, P4AD’s third as part of our US v. Pharma campaign, highlights the transformative relief that lower negotiated prices will deliver to millions of patients and dismantles Big Pharma’s claims that the widely-supported program will stifle future innovation and limit patient access to essential medicines. It also recounts how drug industry lobbying resulted in a two-decades-long prohibition on Medicare’s negotiation authority, leaving patients to bear the burden of exorbitantly high prices dictated by the industry. Patient stories are central to the argument against Boehringer’s claims, including Oluyomi Amoye who shared his difficulty affording Jardiance, which is used to treat his type 2 diabetes, and one of the first 10 drugs selected for negotiation. As ten lawsuits have threatened this hard-fought victory, patients continue to defend lower drug prices in the courtroom and beyond. — (P4AD, Fierce Pharma, KFF, Action Network)

Trump Administration’s First Drug Pricing Action

On his first day in office, President Trump rescinded President Biden’s Executive Order that directed the Centers for Medicare and Medicaid Innovation (CMMI) to develop and test innovative payment and delivery models to reduce drug costs and promote access to drug therapies. These models include the voluntary Medicare $2 Drug List Model to standardize cost-sharing for over a hundred generic drugs at $2 per month, and the Cell and Gene Therapy (CGT) Access Model to help Medicaid patients, starting with those living with sickle cell disease, afford cutting-edge treatments. While the move doesn’t immediately end the models, it raises serious concerns about their future. Experts have called the decision “perplexing,” noting it signals a troubling start for an administration that has pledged to address high drug costs. In a conversation with Inside Health Policy, P4AD President and Founder David Mitchell emphasized the importance of these models as creative solutions consistent with bipartisan goals, urging the administration to move forward with bold initiatives to deliver meaningful relief to patients. P4AD remains committed to working with lawmakers across the political spectrum to advance reforms that make medications affordable for all. — (Politico, Pink Sheet, NBC, Inside Health Policy)

$2k OOP Cap Brings Transformative Relief

Just weeks into the new year, patients are already sharing how the $2,000 annual cap on out-of-pocket costs for people on Medicare is transforming their lives. The cap, which came into effect this month, will provide long-awaited financial relief for 11.3 million Americans struggling with high prescription drug costs. P4AD patient advocate Judy Aiken shared with NPR how she expects to save $7,000 this year on her psoriatic arthritis medication Enbrel – meaning she can consistently take her prescribed medications and finally address much-needed home repairs. Pamela of Rockford, MI, shared with P4AD that she will save $6,000 after years of paying the maximum out-of-pocket costs. “This year I can finally begin to pay down some debt rather than incurring more.” Maureen of Bridgewater, NJ, said she’s already met the cap, saving $4,000 this year. These stories represent just a fraction of the 420,000 patients on Medicare who are projected to save more than $3,000 this year thanks to this critical provision in the 2022 prescription drug law. — (Commonwealth Fund, NPR, AARP)

In Case You Missed It
This week on Capitol Hill, David Mitchell shared his story as a patient living with multiple myeloma, an incurable blood cancer. David highlighted the staggering costs of his treatments, which carry an annual list price of $1 million. Holding up a bottle of his Pomalyst – one of the drugs selected in the second round of Medicare negotiation – David emphasized the urgent need for the successful implementation of the Medicare Negotiation Program. In 2023, Pomalyst cost David over $16,000 for a year’s supply.

Photo by Rod Lamkey, freelance reporter, for The Associated Press Center

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