Aug. 17—Highlighting a host of changes for Medicare beneficiaries that reduce out-of-pocket expenses for prescription drugs, U.S. Sen. Ron Wyden, D-Oregon, joined pharmacy owners Tuesday in Medford to praise passage of the Inflation Reduction Act.
Wyden called the act Tuesday signed by President Joe Biden a "big dose of good news for hundreds of thousands of senior citizens in Southern Oregon and across our state," at a press conference at West Main Pharmacy in west Medford.
The Inflation Reduction Act will limit Medicare patients' insulin costs to $35 per month starting in 2023, will cap out-of-pocket drug costs at no more than $4,000 in 2024, and eventually limit them to $2,000 starting in 2025, according to an official summary of the bill.
"Now we're going to have an out-of-pocket cap that's going to help seniors get off the financial tightrope," Wyden said.
The law also includes new bargaining power for Medicare to negotiate the cost of 100 prescription drugs over the next decade — a change Wyden, who chairs the Senate Finance Committee, described as hard-fought.
"I have worked for years to lift this horrendous prohibition on Medicare being able to negotiate a better deal for senior citizens," Wyden said. "Big Pharma has treated this prohibition almost like they're protecting the holy grail."
"This is a seismic shift in the relationship between seniors, taxpayers and Big Pharma," Wyden added.
Michelle Belcher, owner of Grants Pass Pharmacy and president of the National Community Pharmacists Association, said she and her pharmacists have seen first-hand how drug prices impact patients on fixed incomes.
"I experience on a weekly basis people talking to me about choosing between taking their insulin correctly — meaning every day — or paying the copay that they have," Belcher said.
As an example, a few weeks ago Belcher said she checked on a senior patient who hadn't filled her 30-day insulin prescription in 45 days.
"When I called and asked if her doctor had changed her dosage, she said, 'No, I can't afford the co-pays because I'm in the gap, and so I decided to start taking it every other day,'" Belcher said. "That should not happen to our seniors."
Belcher said the new law will help her patients take their medication as their doctors prescribed, which will improve not only their health but could improve doctors' abilities to treat them.
Many patients are embarrassed to tell their doctor they're not taking their medication as directed, Belcher said. If the doctor sees the patient's not responding to the drug they prescribed that could result in unnecessary dosage or medication changes.
"I think this is going to change my patients' lives," Belcher said.
Wyden said he drew extensively from Belcher's input while crafting the prescription drug reforms on the Senate Finance Committee.
Wyden, Belcher and West Main Pharmacy owner Michael Le said small pharmacies are getting hit hard by pharmacy benefit managers, or PBMs, which offer patients on Medicare Part D and other health insurance plans much lower drug prices for going with a mail-order prescription business with ties to the insurer.
"Independent pharmacies have their back against the wall," Le said.
"Give these small pharmacies a chance to have a level playing field, and not just get pushed off the field by the big guys, these PBMs that are really big insurance outfits who play middlemen," Wyden said.
Starting this fall, according to Wyden, pharmaceutical makers will be required to pay penalties if they raise prices of medications — especially older medications — above the rate of inflation.
"This will be the first time there's ever been anything in Medicare, which began in '65, that really specifically is there to stop price gouging."
The ability to lift a ban on Medicare drug negotiations was a "tough vote," Wyden said, and required Vice President Kamala Harris to break a 50-50 tie.
The Senate Finance Committee plans to target 100 of the costliest medications over the next decade treating everything from arthritis to cancer.
Wyden touched on his efforts to pass a bipartisan prescription drug bill he worked on with Republican Sen. Chuck Grassley, of Iowa, in 2020. During the formation of that bill, which didn't pass, Wyden said there was strong resistance to lifting the ban.
"Everybody in America negotiates ... how in the world can you say that 50 million seniors shouldn't have somebody to negotiate for them going up against Big Pharma," Wyden said.
Wyden said he's next looking toward legislation to reduce prescription drug costs for those who aren't on Medicare.
"I also think it's time to stop price gouging those who aren't yet seniors," Wyden said. "I'm going to be back in September."
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