For older Americans, health bill will bring savings
WASHINGTON — After Pete Spring was diagnosed with dementia in 2016, he and his wife emptied their checking account in part to pay for his prescription drugs, then ran through $60,000 in pension payments before resorting to a charge card to help make sure Spring had the heart and Alzheimer’s medications he needed to survive — just two of the 11 drugs he took.
Spring, of Marietta, Ga., died in April, before the unveiling of the tax, climate and health bill that the Senate passed over the weekend. The measure aims to lower the cost of prescription drugs for people on Medicare, like Spring; his wife, Gretchen Van Zile, has been left to look back on what felt like an outrageous injustice.
“Here seniors are in their golden years,” said Van Zile, 74, “and the only people seeing gold are the pharmaceutical companies.”
Nearly 49 million people, most of them older Americans, get prescription drug coverage through Medicare, yet many find that it does not go very far. Low-income people qualify for government subsidies, so those in the middle class — people Spring and Van Zile — are hit hardest by high drug costs.
The Senate bill, which the House is expected to pass Friday, then send to President Joe Biden’s desk, could save many Medicare beneficiaries hundreds, if not thousands of dollars a year. Its best-known provision would empower Medicare to negotiate prices with drugmakers with the goal of driving down costs — a move the pharmaceutical industry has fought for years, and one that experts said would help lower costs for beneficiaries.
But the legislation would also take more direct steps to keep money in people’s pocketbooks, although they would be phased in over time.
Beginning next year, insulin co-payments for Medicare recipients would be capped at $35 a month. As of 2024, those with costs high enough to qualify for the program’s “catastrophic coverage” benefit would no longer have to pick up 5 percent of the cost of every prescription. And starting in 2025, out-of-pocket costs for prescription medicines would be capped at $2,000 annually.
“This a huge policy change and one that has been a long time coming,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University. “For people needing high-cost drugs, this will provide significant financial relief.”
Between 2009 and 2018, the average price more than doubled for brand-name prescription drugs in Medicare Part D, the program that covers products dispensed by pharmacies, the Congressional Budget Office found. Between 2019 and 2020, price increases outpaced inflation for half of all drugs covered by Medicare, according to an analysis from the Kaiser Family Foundation.
Perhaps no drug has been talked about as much as insulin, a diabetes medication that is more than 100 years old. Prices for insulin and its analogues have risen so fast that many diabetes patients who rely on the drug put themselves at risk by taking less than is prescribed to cut costs.
A 2020 commentary in the medical journal Mayo Clinic Proceedings reporte one vial of Humalog, a commonly prescribed insulin analogue, cost $21 in 1999 and $332 in 2019 — an increase of well over 1,000 percent. (Amid congressional scrutiny, the drug’s maker, Eli Lilly, promised in 2019 to market a lower-cost generic version.)
More than 3 million Medicare beneficiaries take one of the 42 types of insulin that are covered by Medicare, according to an estimate by the Kaiser Family Foundation, which found that the average out-of-pocket cost is $54 a month. But for some people, the costs are much higher.