Retired Nurse Judy Aiken Highlighted Her Lived-Experience With High Drug Prices, Shared How The Out-of-Pocket Cap And Medicare Negotiation Feels Like A “Lifeline”
WASHINGTON, D.C. — Judy Aiken, a retired nurse and P4ADNOW patient advocate from Portland, Maine testified today before the Senate Finance Committee at a hearing titled “Lower Health Care Costs for Americans: Understanding the Benefits of the Inflation Reduction Act” about the relief being delivered to patients via the drug price reforms in the historic Inflation Reduction Act.
Judy, who has battled psoriatic arthritis and psoriasis for over four decades, emphasized how the drug price law has already reined in her soaring out-of-pocket costs; Prior to the passage of the Inflation Reduction Act, Judy paid more than $9,000 out-of-pocket in a single year for Enbrel alone.The Inflation Reduction Act’s out-of-pocket cap reduced her prescription drug costs to about $3,300 in 2024 — nearly a third of what she paid last year. In 2025, her annual out-of-pocket expenses will be capped at $2,000.Judy also highlighted the additional relief she will experience beginning in 2026 thanks to the historic Medicare negotiation program, which for the first time in two decades allows Medicare to negotiate some of the costliest and most common drugs covered by Medicare; Enbrel, one of her prescribed medications, is among the first 10 drugs selected for negotiation.Starting in 2026, Enbrel’s negotiated price will be $2,355 per month, a 67 percent reduction from its current monthly list price.As someone who has worked as a nurse for four decades, Judy knows firsthand the importance of adhering to a consistent medication regimen. “But the cruel irony is that I’ve sometimes found myself skipping doses, unable to follow my own advice due to the prohibitive cost,” Judy shared in her testimony.
But now, the drug price reforms are lessening the financial strain of high-cost prescription drugs for millions of patients like Judy. She also shared that, “The impact of these changes cannot be overstated. My husband and I can now breathe easier. We’re addressing those long-postponed home repairs. And we may even be able to take a trip. But most importantly, I no longer have to choose between my health and our financial stability.
This is the real, tangible impact of the Inflation Reduction Act. It’s not just about numbers on a page or political talking points. It’s about people – seniors like me, who have worked hard their whole lives, and who can now afford the medications we need to live healthier, more productive lives with dignity.”
FIND JUDY’S FULL TESTIMONY BELOW:
Chairman Wyden, Ranking Member Crapo, Committee Members
Thank you for inviting me to share my story today.
I’m Judy Aiken – a 70-year-old retired nurse, born and raised in Portland, Maine, where I live with my husband of 47 years.
I have been battling psoriatic arthritis and psoriasis for over four decades. These conditions have taken a heavy toll on my body, but the financial strain of the medications I need has been equally challenging.
Seventeen years ago, my doctor prescribed Enbrel to manage my condition. It’s been a lifeline, but one with a staggering price tag. Since its introduction 26 years ago, Enbrel’s price has skyrocketed by more than 700 percent. Today, it is priced at $7,106 for a 30-day supply.
Last year alone, I paid over $9,000 out-of-pocket just for this one medication. The cost was overwhelming. As a nurse, I spent years counseling patients on the importance of taking their medications consistently. But the cruel irony is that I’ve sometimes found myself skipping doses, unable to follow my own advice due to the prohibitive cost.
Every trip to the pharmacy was a source of anxiety. How much would it cost this time? Could we afford it? What else would we have to sacrifice? My husband and I were constantly juggling our budget – we postponed home repairs and stopped going out to eat.
Then came the Inflation Reduction Act, and with it, a glimmer of hope.
This year, I braced for another 12 months of expensive pharmacy visits. But after paying $2,150 in January and $1,141 in February, a real shock came in March. I went to pick up my prescription and discovered my out-of-pocket cost would be $0 for the rest of the year. I nearly cried at the pharmacy counter. Even after advocating for the passage of the drug price reforms in the Inflation Reduction Act, I was skeptical it would actually benefit me. But it has, and this year my out-of-pocket costs have been capped at $3,300.
And there’s more relief on the horizon. Next year, the out-of-pocket limit will drop further, capping at $2,000 for everyone on Medicare Part D. For patients like me who rely on expensive medications, this is truly life-changing.
But that’s not the only IRA provision that I will benefit from. Enbrel was one of the first 10 drugs selected for Medicare price negotiation. After the inaugural round of negotiated prices were released in August, I learned that beginning in 2026, Enbrel’s price will be reduced to $2,355 per month – a 67 percent reduction.
These lower negotiated prices come after decades of advocacy from patients like me and represent the first time in Medicare’s history that the program has directly negotiated drug prices with pharmaceutical corporations. These 10 drugs cover treatments for common conditions such as diabetes, heart disease, and blood clots, and the roughly nine million patients on Medicare who take at least one of these drugs are projected to save $1.5 billion out of pocket in 2026 alone.
It’s important to note that the out-of-pocket savings are made possible by lowering the prices. We cannot do one without the other.
The impact of these changes cannot be overstated. My husband and I can now breathe easier. We’re addressing those long-postponed home repairs. And we may even be able to take a trip. But most importantly, I no longer have to choose between my health and our financial stability.
This is the real, tangible impact of the Inflation Reduction Act. It’s not just about numbers on a page or political talking points. It’s about people – seniors like me, who have worked hard their whole lives, and who can now afford the medications we need to live healthier, more productive lives with dignity.
The IRA demonstrates that when our elected leaders take action, real change is possible. While there’s still work to be done to make prescription drugs affordable for all Americans, this is a huge step in the right direction.
I urge you to continue supporting and strengthening these life-saving reforms. They are making a real difference in the lives of millions of American patients.
Thank you for your time and attention to this crucial issue. I look forward to answering your questions.
###
Patients for Affordable Drugs Now, is the only national, patient advocacy organization focused exclusively on policies to lower drug prices. We empower and mobilize patients and allies, hold accountable those in power, and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4ADNow is bipartisan and does not accept funding from organizations that profit from the development or distribution of prescription drugs. To learn more visit PatientsForAffordableDrugsNOW.org.
Retired Nurse Judy Aiken Highlighted Her Lived-Experience With High Drug Prices, Shared How The Out-of-Pocket Cap And Medicare Negotiation Feels Like A “Lifeline”
| WASHINGTON, D.C. — Judy Aiken, a retired nurse and P4ADNOW patient advocate from Portland, Maine testified today before the Senate Finance Committee at a hearing titled “Lower Health Care Costs for Americans: Understanding the Benefits of the Inflation Reduction Act” about the relief being delivered to patients via the drug price reforms in the historic Inflation Reduction Act. Judy, who has battled psoriatic arthritis and psoriasis for over four decades, emphasized how the drug price law has already reined in her soaring out-of-pocket costs;Prior to the passage of the Inflation Reduction Act, Judy paid more than $9,000 out-of-pocket in a single year for Enbrel alone.The Inflation Reduction Act’s out-of-pocket cap reduced her prescription drug costs to about $3,300 in 2024 — nearly a third of what she paid last year.In 2025, her annual out-of-pocket expenses will be capped at $2,000.Judy also highlighted the additional relief she will experience beginning in 2026 thanks to the historic Medicare negotiation program, which for the first time in two decades allows Medicare to negotiate some of the costliest and most common drugs covered by Medicare; Enbrel, one of her prescribed medications, is among the first 10 drugs selected for negotiation.Starting in 2026, Enbrel’s negotiated price will be $2,355 per month, a 67 percent reduction from its current monthly list price.As someone who has worked as a nurse for four decades, Judy knows firsthand the importance of adhering to a consistent medication regimen. “But the cruel irony is that I’ve sometimes found myself skipping doses, unable to follow my own advice due to the prohibitive cost,” Judy shared in her testimony. But now, the drug price reforms are lessening the financial strain of high-cost prescription drugs for millions of patients like Judy. She also shared that, “The impact of these changes cannot be overstated. My husband and I can now breathe easier. We’re addressing those long-postponed home repairs. And we may even be able to take a trip. But most importantly, I no longer have to choose between my health and our financial stability. This is the real, tangible impact of the Inflation Reduction Act. It’s not just about numbers on a page or political talking points. It’s about people – seniors like me, who have worked hard their whole lives, and who can now afford the medications we need to live healthier, more productive lives with dignity.” |
| FIND JUDY’S FULL TESTIMONY BELOW: Chairman Wyden, Ranking Member Crapo, Committee Members Thank you for inviting me to share my story today. I’m Judy Aiken – a 70-year-old retired nurse, born and raised in Portland, Maine, where I live with my husband of 47 years. I have been battling psoriatic arthritis and psoriasis for over four decades. These conditions have taken a heavy toll on my body, but the financial strain of the medications I need has been equally challenging. Seventeen years ago, my doctor prescribed Enbrel to manage my condition. It’s been a lifeline, but one with a staggering price tag. Since its introduction 26 years ago, Enbrel’s price has skyrocketed by more than 700 percent. Today, it is priced at $7,106 for a 30-day supply. Last year alone, I paid over $9,000 out-of-pocket just for this one medication. The cost was overwhelming. As a nurse, I spent years counseling patients on the importance of taking their medications consistently. But the cruel irony is that I’ve sometimes found myself skipping doses, unable to follow my own advice due to the prohibitive cost. Every trip to the pharmacy was a source of anxiety. How much would it cost this time? Could we afford it? What else would we have to sacrifice? My husband and I were constantly juggling our budget – we postponed home repairs and stopped going out to eat. Then came the Inflation Reduction Act, and with it, a glimmer of hope. This year, I braced for another 12 months of expensive pharmacy visits. But after paying $2,150 in January and $1,141 in February, a real shock came in March. I went to pick up my prescription and discovered my out-of-pocket cost would be $0 for the rest of the year. I nearly cried at the pharmacy counter. Even after advocating for the passage of the drug price reforms in the Inflation Reduction Act, I was skeptical it would actually benefit me. But it has, and this year my out-of-pocket costs have been capped at $3,300. And there’s more relief on the horizon. Next year, the out-of-pocket limit will drop further, capping at $2,000 for everyone on Medicare Part D. For patients like me who rely on expensive medications, this is truly life-changing. But that’s not the only IRA provision that I will benefit from. Enbrel was one of the first 10 drugs selected for Medicare price negotiation. After the inaugural round of negotiated prices were released in August, I learned that beginning in 2026, Enbrel’s price will be reduced to $2,355 per month – a 67 percent reduction. These lower negotiated prices come after decades of advocacy from patients like me and represent the first time in Medicare’s history that the program has directly negotiated drug prices with pharmaceutical corporations. These 10 drugs cover treatments for common conditions such as diabetes, heart disease, and blood clots, and the roughly nine million patients on Medicare who take at least one of these drugs are projected to save $1.5 billion out of pocket in 2026 alone. It’s important to note that the out-of-pocket savings are made possible by lowering the prices. We cannot do one without the other. The impact of these changes cannot be overstated. My husband and I can now breathe easier. We’re addressing those long-postponed home repairs. And we may even be able to take a trip. But most importantly, I no longer have to choose between my health and our financial stability. This is the real, tangible impact of the Inflation Reduction Act. It’s not just about numbers on a page or political talking points. It’s about people – seniors like me, who have worked hard their whole lives, and who can now afford the medications we need to live healthier, more productive lives with dignity. The IRA demonstrates that when our elected leaders take action, real change is possible. While there’s still work to be done to make prescription drugs affordable for all Americans, this is a huge step in the right direction. I urge you to continue supporting and strengthening these life-saving reforms. They are making a real difference in the lives of millions of American patients. Thank you for your time and attention to this crucial issue. I look forward to answering your questions. |
| ### Patients for Affordable Drugs Now, is the only national, patient advocacy organization focused exclusively on policies to lower drug prices. We empower and mobilize patients and allies, hold accountable those in power, and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4ADNow is bipartisan and does not accept funding from organizations that profit from the development or distribution of prescription drugs. To learn more visit PatientsForAffordableDrugsNOW.org. |
Welcome to the Week in Review.
P4ADNow Six-Figure Ad Campaign
P4ADNow has launched a six figure ad campaign featuring patients urging legislators to pass a package of bipartisan bills to reform our patent system and lower drug prices. These ads are part of our “Push For Competition To Lower Drug Prices” to advance key legislation in both the House and Senate. The bills include:
The Senate has already unanimously passed an amended version of S.150, which would address patent thickets, signaling a growing appetite from legislators on both sides of the aisle to reform the patent system. Collectively, these Senate bills are estimated to save taxpayers $4.5 billion over the next 10 years. Building on this momentum and to continue pushing for additional bills, P4ADNow and other organizations are planning lobby days on The Hill over the coming weeks.
Big Pharma and its allies are simultaneously pushing harmful patent legislation, including S. 2220 (PREVAIL Act) and S. 2140 (Patent Eligibility Restoration Act). On Wednesday, we sent a letter to members of the Senate Judiciary Committee to urge them to vote NO on these bills which would hurt patients. We will continue in our efforts to protect patients and ensure that they are prioritized over industry profits. With growing bipartisan support and patient voices leading this effort, we’re closer than ever to achieving meaningful patent reform. — (Inside Health Policy)
Court Watch: US v. Pharma
Yesterday, P4AD filed an amicus brief in the Third Circuit Court of Appeals in lawsuits brought by Bristol Myers Squibb (BMS), Janssen, and AstraZeneca. The brief incorporates the stories of several patients on Medicare who have struggled to afford their medications due to high cost and highlights how lower negotiated prices will make their drugs more affordable. It also counters pharma’s misleading claims about the Inflation Reduction Act, explaining how Medicare negotiation fosters innovation while expanding patient access to life-saving treatments. Additionally, the brief pushes back against industry-funded groups that falsely claim to represent patients, exposing their role in preserving pharma’s monopoly pricing. Earlier this week, the Department of Health and Human Services (HHS) filed an opposition brief in the cases brought by BMS and Janssen, underscoring the voluntary nature of Medicare negotiations. Oral arguments will be presented in all three cases on October 28th. Despite the drug industry’s seven failed attempts to block Medicare negotiations in court, patients remain vigilant, continuing to defend the law both in the courtroom and in public advocacy efforts. — (P4AD, Bloomberg Law, O’Neill Institute, FightPharma.org)
Out-Of-Pocket Cap Delivers Savings
The Inflation Reduction Act’s annual cap on out-of-pocket costs has already delivered substantial cost savings for patients living with cancer. A University of Michigan study published in JAMA found that the average median cost savings for patients on Medicare Part D taking oral cancer medications, as a result of the out-of-pocket cap, is estimated to be more than $7,000 in 2024. Patients with cancer routinely face steep out-of-pocket costs, upwards of $10,000 a year for their medications. For almost a decade, Jackie Trapp paid over $15,000 annually for her cancer medication Revlimid, but this year because of the IRA her costs were capped at $3,300. The IRA is a victory for patients faced with expensive prescription drugs and we look forward to further savings for patients next year when the cap is further reduced to $2,000. — (MedicalXpress, JAMA, P4AD)
ICYMI
Reforms to lower drug prices continue to have broad bipartisan support from voters. New polling from Navigator Research reveals that 86 percent of Americans support expanding Medicare’s authority to negotiate for lower drug prices and 82 percent support capping the price of insulin at $35 a month, viewing these measures as an essential step towards delivering relief to American families.
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Patients For Affordable Drugs NOW Steps Up Push For Competition to Lower Drug Prices Including Six-Figure Ad Campaign
Ads, Letters, Lobby Day in Coming Weeks Urge Congress To Pass Bills To Boost Competition and Reform Patent Law To Lower Drug Prices
WASHINGTON, D.C. — Patients For Affordable Drugs Now (P4ADNow) has launched a six-figure ad campaign to urge Congress to pass a package of bipartisan bills that crack down on the drug industry’s anti-competitive practices in order to lower prescription drug prices for patients. The ads are the latest effort in P4ADNow’s continued “Push For Competition To Lower Drug Prices”, focusing on reforming patent laws and closing regulatory loopholes to promote generic and biosimilar competition and curbing anti-competitive tactics that allow drug companies to keep prices high by extending unwarranted monopolies on life-saving medications.
The campaign, which includes a combination of video, audio, and static ads, are running on digital and social media platforms and features Lisa McRipley, a patient with multiple sclerosis (MS), whose vital medications have a price of nearly $7,500 each month, and Jacqueline Garibay, a patient who lives with ankylosing spondylitis, an autoimmune disorder, and has had to go without her medication at times because of the $6,000 per month cost. View Lisa’s ad here.
“Patients like Lisa and Jacqueline are struggling to afford the medications they depend on because drug companies have been manipulating the patent system for decades to maintain their monopoly power and keep prices high,” said Merith Basey, Executive Director of Patients For Affordable Drugs Now. “Legislators can act during this Congress to pass this package of bipartisan legislation to increase competition and curb pharma’s abusive practices to ensure that affordable generics and biosimilars can enter the market, lower prices, and begin to bring overdue relief to patients.
“Lowering drug prices isn’t just a policy priority – it’s a public mandate. Patients, consumers, and taxpayers are calling for action – with 9 in 10 voters saying Congress should prioritize policies to lower drug prices. Congress has the power and the bipartisan support to pass these competition bills and make medications more affordable for all Americans. It’s high time we curb drug companies’ abusive practices – Congress can get it done this year.”
Anti-competitive practices in the pharmaceutical industry including patent thicketing, pay-for-delay agreements, and product hopping, have led to inflated drug prices, costing patients and taxpayers billions. When generic or biosimilar versions enter the market, prices can fall dramatically – by nearly 40 percent when there is one additional competitor and 85-95 percent when there are six or more competitors.
In 2023, the Senate Judiciary Committee unanimously passed several bipartisan bills to improve competition in the prescription drug market and in July this year, the Senate unanimously passed the amended Affordable Prescriptions for Patients Act of 2023 (S.150) – which targeted the pharmaceutical industry’s use of patent thickets.
The House now has the chance to build on that momentum. By advancing additional bipartisan competition bills, including H.R. 9070 and H.R. 6986, Congress can bring relief to patients like Lisa, Jacqueline, and millions of others burdened by excessive drug costs. These bills are projected to save taxpayers more than $4.5 billion over the next ten years.
BACKGROUND
###
Patients for Affordable Drugs NOW, is the only national, bipartisan patient advocacy organization focused exclusively on policies to lower drug prices. We empower and mobilize patients and allies, hold accountable those in power, and fight to shape and achieve system-changing policies that make prescription drugs affordable for all people in the United States. P4ADNOW does not accept funding from organizations that profit from the development or distribution of prescription drugs. To learn more visit PatientsForAffordableDrugsNOW.org.
Welcome to the Week in Review.
Patients Push For Competition
On Friday, a group of organizations representing patients, seniors, and employers sent a letter to members of the House Judiciary Committee calling for urgent action on bipartisan legislation in Congress to lower drug prices. The letter urges committee leaders to advance bipartisan bills in the House aimed at reducing Big Pharma’s anti-competitive patent abuses that artificially extend monopolies and keep drug prices high. In addition to Patients for Affordable Drugs Now, the letter was signed by AARP, the Campaign for Sustainable Rx Pricing (CSRxP), the ERISA Industry Committee, the Purchaser Business Group on Health, and the National Multiple Sclerosis (MS) Society. The letter detailed abusive tactics such as patent thicketing, product hopping, and pay-for-delay schemes, emphasizing the need for action by the House Judiciary Committee to improve drug pricing competition before the end of the year. The Senate Judiciary Committee has already passed several bipartisan bills to boost competition in the prescription drug market, which are estimated to save taxpayers more than $4.5 billion over the next decade. To maintain momentum on this issue, this week, CSRxP, one of the letter’s signatories, launched a seven figure ad campaign to raise awareness of pharma’s anti-competitive tactics and urge lawmakers to take action. As Congress returns from recess, it’s crucial that legislators heed the demands of patients and consumers by advancing bipartisan bills to reform the patent system and reduce prescription drug costs. — (patientspushforcompetition.org, Axios)
P4AD Advocates In the News
P4AD advocates are continuing to spotlight the historic relief being delivered through the Inflation Reduction Act. On Tuesday, Jackie Trapp, a retired educator from Wisconsin living with multiple myeloma, participated in a virtual White House call and shared how Medicare’s out-of-pocket spending cap has reduced the financial burden of her prescription drugs. After nine years of paying between $15,000 to $21,000 annually for her cancer medication, Jackie told the President during the event that she was able to celebrate the New Year knowing that she wouldn’t have to pay more than $3,300 in January this year after she met the cap, and in 2025, her spending would be further reduced to $2,000 annually. Another patient advocate Judy Aiken was featured in her hometown newspaper, the Portland Press Herald, after introducing both President Biden and Vice President Harris at an event in August celebrating the new lower drug prices under Medicare negotiation. Judy shared how her out-of-pocket costs for her psoriasis and psoriatic arthritis medication Enbrel, which used to cost her over $9,000 a year, have been cut in half this year because of the out-of-pocket cap. The historic drug price law wouldn’t have crossed the finish line without the tireless advocacy of patients like Judy and Jackie, and as the reforms continue to take effect, P4AD will continue to amplify their voices, showcasing the real impact of this hard-fought victory on millions of Americans. — (Spectrum News, The White House, UPI, Courthouse News, Newsweek, Portland Press Herald)
ICYMI
Reforms to lower drug prices continue to have broad bipartisan support from voters. New polling from Navigator Research reveals that 86 percent of Americans support expanding Medicare’s authority to negotiate for lower drug prices and 82 percent support capping the price of insulin at $35 a month, viewing these measures as an essential step towards delivering relief to American families.
Subscribe to the WEEK IN REVIEW here.
Welcome to the Week in Review.
Historic Drug Prices Law Bring In Savings
The drug price reforms in the historic Inflation Reduction Act are already delivering relief to patients who depend on costly prescription drugs. And even more savings are expected as the law continues to be successfully implemented. A new report from AARP released on Wednesday found that approximately 1.1 million patients on Medicare are expected to reach the new $2,000 out-of-pocket cap between 2025 and 2029 and are estimated to see average savings of $1,100 a year. Further, more than 420,000 people will see annual savings exceeding $3,000 per year. Leigh Purvis, the in AARP’s Prescription Drug Policy Principal and author of the report, emphasized that the $2,000 cap on out-of-pocket costs will shield patients on Medicare who’ve historically had to pay 5 percent of their high-cost prescription drugs in the catastrophic phase, with no limit on the total, resulting in out-of-pocket costs often exceeding $10,000 per year. In addition this week, an analysis released by the Senate Finance Committee on the provision in the drug price law which penalizes drug companies for hiking prices faster than the rate of inflation has shown that it is yielding significant cost savings. The Committee highlighted that the drug companies responsible for price gouging 98 Medicare Part B drugs have been penalized under the inflation rebate program which took effect in January 2023, and as a result, has saved patients and taxpayers $3 billion. Before the passage of the Inflation Reduction Act, drug companies had unfettered power to dictate prices to Medicare, forcing patients to pay excessive amounts for their essential medicines. Now, with these curbs on pharma’s monopoly power firmly in place, patients and taxpayers are finally beginning to get a better deal. — (AARP, Reuters, Senate Finance Committee)
Eli Lilly’s Pump Fake
On Tuesday, Eli Lilly launched discounted versions of its weight loss drug Zepbound. The discounts however will apply only to low-dose vials of the drug sold exclusively through its direct-to-consumer online portal and will only be made available for patients without insurance. Eli Lilly’s claims in its press release that the decision is “expanding access and supply” received sharp criticism throughout the week for grossly misrepresenting who the plan would help. The discounted low-dose vials of Zepbound — previously available as injectable pens with a list price of $1,060 per month — will still remain wildly cost prohibitive at their discounted $399 list price for a monthly supply of 2.5 mg vials. Uncoincidentally, on the very same day that Eli Lilly made the discounted vials available, the company quietly increased the price of its autoinjector pen for patients with commercial insurance but without coverage for the treatment, hiking the monthly list price from $550 to $650. Drug corporations like Eli Lilly have arbitrarily hiked prices on insulins for decades and these limited price reductions are a reminder that leopards don’t change their spots. Innovation is worthless if patients can’t access the medicines they need at prices they can afford. — (STAT, Market Watch)
ICYMI
A major new poll of seven diverse states, commissioned by More Perfect Union Foundation, revealed widespread support for measures aimed at delivering relief to patients facing high prescription drug prices. 91 percent of respondents shared that they support the government taking further action to reduce the prices of cancer drugs and 90 percent of respondents support capping prices on inhalers, insulin, and other medical devices.
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Welcome to the Week in Review.
Medicare Negotiation Promises Big Savings
Medicare’s first-ever lower negotiated drug prices will deliver substantial savings for patients and taxpayers when the lower costs take effect in 2026. Lower negotiated prices for just three of the first 10 drugs selected — Enbrel, Stelara, and Eliquis — will account for more than half of the $6 billion in taxpayer savings projected for the first year, according to the Brookings Institution. In a Centers for Medicare and Medicaid (CMS) press release, CMS illustrated a hypothetical example of a patient benefitting from Medicare negotiation: “a senior with Medicare who takes Stelara pays a 25% coinsurance on the drug which may amount to about $3,400 today for a 30-day supply. When the negotiated price goes into effect in 2026, that same 25% coinsurance would cost the beneficiary about $1,100 before the person reaches the catastrophic cap, after which the beneficiary will pay no more out of pocket on their prescription drugs. A beneficiary’s actual costs will depend on their plan’s benefit design.” The lower negotiated prices will offer more breathing room to the millions of patients on Medicare who pay three to eight times what residents in comparable countries pay for these same medications. The implementation of Medicare negotiation marks a pivotal shift in U.S. drug price policy, promising significant relief while maintaining critical innovation that patients need. P4AD will continue advocating to expand these efforts to ensure lower drug prices for all Americans. — (Brookings Institution, Centers For Medicare and Medicaid Services, Commonwealth Fund)
Keeping Our Foot On The Gas
Big Pharma’s monopoly pricing power stems in part from systematic abuses of our patent and regulatory systems, which they manipulate to maintain high prices and delay lower-cost competition from entering the market. Drug manufacturers employed tactics such as pay-for-delay agreements, patent thickets, and product hopping to extend their exclusivity periods on the first 10 negotiated drugs for years. A report from Accountable.US highlighted the blood thinner medication Xarelto as a “prime example” of abusing patent thickets to extend exclusivity periods. Johnson & Johnson, the drug’s manufacturer, filed 49 patents on Xarelto, resulting in over a decade of added market exclusivity and price hikes. Amgen, the manufacturer of the autoimmune disease drug Enbrel, has filed 57 patent applications since the drug came to market in 1990, with 72 percent of applications coming after initial approval by the Food and Drug Administration (FDA). These practices underscore the urgent need for legislative action to increase competition and lower drug prices for patients. Currently, there are bipartisan bills in Congress, which have already passed out of Senate committees and which aim to curb pharma’s abuses of the system. These bills are projected to save taxpayers $5 billion over ten years. Earlier this month, the Senate unanimously passed S. 150, the Affordable Prescriptions for Patients Act of 2023, which would address patent thicketing in the biologic market. As Congress returns from recess in September, we urge members in the House to take swift action to build off this momentum and finish the job. We will continue to push for further Senate action to pass the additional bipartisan bills which will enable competition and market forces to lower prices for millions of patients. — (Accountable.US, P4AD, patientspushforcompetition.org)
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Welcome to the Week in Review.
“It’s a relief I never thought I’d have”
On Thursday the Centers For Medicare & Medicaid Services (CMS) published the first-ever, lower negotiated prices for all 10 high-cost drugs selected for the inaugural round of Medicare negotiation as part of the Inflation Reduction Act (IRA). These lower negotiated prices, which take effect in 2026, come after six months of back-and-forth between CMS and drug manufacturers and promise substantial price reductions ranging from 38 to 79 percent for roughly nine million patients who take these medications. Medicare negotiation drove down prices by more than 75 percent for diabetes medications Januvia and Fiasp/NovoLog insulins, promising hundreds of dollars of monthly savings, and significantly reduced the high-priced irritable bowel drug Stelara, which had a 2023 list price of $13,836, by more than 65 percent. These lower prices are expected to save patients $1.5 billion in out-of-pocket in 2026 when they come into effect, and taxpayers will save an estimated $6 billion. Medicare negotiation will mean more breathing room for patients like Judy Aiken, a retired nurse who lives with psoriatic arthritis and psoriasis and relies on Enbrel. Judy had the opportunity to share her story directly with President Biden this week as well as introduce him and Vice President Harris at an event in Maryland focused on the new lowered costs. “A lower negotiated price for Enbrel and the nine other medications will lift the financial burden off the shoulders of seniors like me. It’s a relief I never thought I’d have,” Judy shared in her remarks. After decades of advocacy, Medicare can now leverage its negotiating authority to tackle inflated prices of drugs used to treat conditions like cancer, diabetes, heart failure, and chronic conditions – proving that change is possible when patients demand it. — (Centers For Medicare and Medicaid Services, NPR, Axios, The New York Times, Newsweek)
Patients Celebrate The IRA During Second Anniversary
Throughout the week, P4AD patient advocates and allies shared how over the last two years the drug price reforms in the Inflation Reduction Act have begun to tackle high prescription drug costs. On Tuesday, Bob Parant, who has lived with type 1 diabetes for over 50 years, and Steven Hadfield, a patient living with type 2 diabetes, participated in a White House panel about the impact of the $35 monthly insulin copay cap. On Wednesday, Kaye Peterson, a retired librarian from KY, who has lived with type 1 diabetes for over 40 years, and Judy Aiken, who suffers from psoriatic arthritis and psoriasis, took part in a celebratory patient community call hosted by P4AD Founder David Mitchell and AARP, with Department of Health and Human Services Secretary Xavier Becerra participating as a special guest. On the call, Secretary Becerra said that patients can “blow out the candles” to commemorate their tireless advocacy in achieving the reforms in the IRA. Earlier that day, Jackie Trapp, a former educator from Muskego, WI, participated in a press call alongside Senator Amy Klobuchar, P4AD Executive Director Merith Basey, and Accountable.US Executive Director Tony Carrk to discuss the new, lower negotiated prices under Medicare. Jackie takes Xarelto which had a 2023 list price of $517 but after negotiation will be priced at $197 in 2026 — a 62 percent price reduction. Patients fought hard to usher in this new era of lower drug prices through the reforms in the Inflation Reduction Act and as we celebrate this momentous anniversary, we recognize that while significant progress has been made, our work continues to expand these reforms so that every patient can have access to the drugs they need at prices they can afford. — (Salon, NBC Nightly News)
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