Joseph R, Anticaglia, MD
Medical Advisory Board
A retired Army veteran came to my office years ago complaining of sinus pain and sinus pressure, thick greenish-yellowish discharge, stuffy nose and a slight fever. I prescribed an antibiotic, decongestant medications, one to be taken by mouth, the other a nasal spray as well as medication for pain.
“Jack, can you get this prescription filled at the V. A. pharmacy?”
“Sure, but it doesn’t matter. I can go to my neighborhood pharmacy”
“Please, go to the V. A. It’s only a few blocks from where you live.”
For decades, the U. S. Department of Veteran Affairs has negotiated drug prices with Big Pharma realizing significant savings for the men and women who served in the armed forces. In Jack’s case, he would have spent three times the amount of out-of-pocket money, if he had gone to his local drug store.
The Centers for Medicare and Medicaid Services, or CMS, reported that Medicare paid more than $50 billion for drugs between June 1, 2022, and May 31. And out-of -pocket money for the ten drugs listed below cost Medicare patients in 2022 approximately3.4 billion dollars.
Recent government legislation empowered Medicare to directly negotiate prescription drug prices with the drug industry to get a better deal for seniors. A list of ten drugs were selected by HHS, (U. S. Department of Health and Human Services) for price negotiation.
President Joe Biden, on August 29th, 2023, praised the Inflation Reduction Act and the anticipated out-of pocked savings to Medicare recipients and the overall lowering of drug costs to the Medicare program. Medicare covers about 65,700,000 Americans, and the price negotiations between CMS and Big Pharma is expected to be contentious. The drugs on the groundbreaking list are prescribed to treat diabetes, heart failure and other conditions.
Approximately one quarter of adults were unable to afford medications, at least once, in the past year and this includes Americans who are fully insured or on Medicare. People had to decide either to “fill a prescription or fill their refrigerator with food.” Below is the initial list of drugs included in the drug price negotiation program.
The only drugs that can be selected for negotiation “are drugs that have been in market for a long period of time,” says Mariana Socal, PhD, Johns Hopkins, School of Public Health. “On this list there are drugs that have been in use for nine years if it’s a conventional drug and 13 years if it’s a biologic drug.” (see glossary)
Continues Dr. Socal: “These drugs do not have competition, in spite of being on the market for years.” They represent the top spending drugs targeted by the Medicare program. One of the drugs on the list, “Enbrel, has been on the market since 1999. It’s estimated that this drug will become a generic medication in 2029.”
Another drug “Imbruvica, has been in the market for 10 years. The cost of one pill is $700,” said Dr. Socal. Patients need to take the pill daily for many months. When you calculate the cost on a quarterly or annual basis, even with the help of your insurance, the drug becomes an enormous financial burden for the average senior citizen.
Government and the private sector need to work for senior citizens (and others) to lower the cost of medications. Both patients and taxpayers benefit from such cooperation — and in the long term, pharmaceutical companies.
Conventional drugs are totally synthesized from chemical reactions.
Biologic drugs are substances extracted or produced from biologic entities.
Medical debt has become a leading cause of personal bankruptcy for individuals in the United States.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.
