Both FPs, Patients Benefit From Inflation Reduction Act
AAFP Advocacy to Lower Drug Costs Pays Off
Dec. 22, 2022, 4:18 p.m. News Staff — If you see Medicare and Medicaid patients in your practice, chances are you’ve heard stories about how they or someone they know has struggled to afford much-needed medications. In some instances, patients have been forced to ration their use of therapeutic agents such as insulin, putting themselves at risk of significant harm.
The Inflation Reduction Act of 2022 enacted earlier this year aims to address this public health threat by capping some prescription drug costs and lowering patients’ out-of-pocket expenses, actions the AAFP has been pushing legislators to take.
Law Takes Aim at Cost Barriers
Signed into law on Aug. 16, the Inflation Reduction Act will start tackling drug and vaccine costs as early as next year for Medicare beneficiaries with prescription drug coverage and adults with Medicaid coverage. Among beneficiaries with Medicare Part D coverage who take insulin, for example, out-of-pocket insulin costs will be capped at $35 for a month’s supply of each covered insulin product dispensed at a pharmacy or through a mail-order pharmacy beginning Jan. 1. In addition, no Part D deductible will be applied to covered insulin products.
Similarly, starting July 1, 2023, people with traditional Medicare who take insulin through a traditional pump covered under Medicare’s Part B durable medical equipment benefit won’t pay any deductible, and cost-sharing will be capped at $35 for a month’s supply of that insulin.
Also taking effect on Jan. 1, covered Part D adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (e.g., shingles and tetanus-diphtheria-acellular pertussis vaccines) will become available with no patient cost-sharing to those with Medicare Part D coverage. Beginning Oct. 1, 2023, adults covered by Medicaid and CHIP also will be guaranteed coverage of ACIP-recommended vaccines at no cost. By contrast, states currently are free to set their own vaccine coverage and cost-sharing policies for many adult Medicaid beneficiaries, which creates barriers to preventive vaccinations.
Story Highlights
This more standardized health coverage policy stands to reduce confusion and administrative burden for physicians and patients, in addition to improving utilization of preventive vaccines among low-income adults.
Report Offers Road Map to Legislation
According to a January 2021 report from HHS’ Office of the Assistant Secretary for Planning and Evaluation that was based on National Health Interview Survey data, more than 5 million Medicare beneficiaries — 3.5 million adults 65 and older and 1.8 million younger than 65 — had difficulty affording their medications in 2019. Among those 65 and older, Black and Latino beneficiaries were most likely to have trouble affording prescription drugs, at rates 1.5 to 2 times higher than that for their white counterparts.
“Beneficiaries with chronic conditions such as diabetes and those with lower incomes were also more likely to experience these challenges,” said the report’s authors. “Our findings indicate substantial disparities in access to needed medications among Medicare beneficiaries.”
The report went on to suggest tactics Congress and the White House could consider to lessen the cost burden for patients.
“Potential approaches to improving affordability of prescription drugs in Medicare include direct price negotiations to reduce the cost of expensive medications, limitations on price increases over time, changes to the Medicare Part D benefit to reduce patient cost-sharing and cap beneficiaries’ out-of-pocket spending and applying Part D pharmacy price concessions at the point of sale,” said the authors.
AAFP Advocacy Reaps Rewards
As medical specialists who provide preventive care services and manage chronic conditions across the lifespan, family physicians have serious skin in the game when it comes to optimizing patients’ health outcomes. So it’s no wonder the AAFP advocated for these commonsense measures, including by calling on House leaders in April to pass legislation capping insulin costs, and imploring leaders on the Senate side in July to “eliminate cost barriers to essential vaccines and insulin and lower prescription drug costs.”
The benefits clearly go both ways. Consider this example: One of the most common chronic conditions in the United States, more than 37 million people have diabetes. Family physicians routinely care for these patients, many of whom require insulin. When patients can afford the insulin their family doctor has prescribed, they’re more likely to adhere to treatment. That, in turn, can translate to not only better outcomes for patients but also better quality-of-care scores for physicians and possible incentive payments.
Members can view a timeline explaining when various provisions of the act take effect. An online FAQ is also available to answer questions about the new law’s other health care-related benefits, which extend beyond those discussed here.