IRA’s “negotiated” prices represent much #MoreThanAList when considering access impacts and lack of savings for millions of chronic disease patients
August 15, 2024 (WASHINGTON, DC) The Partnership to Fight Chronic Disease (PFCD) today released the following statement in response to the Centers for Medicare and Medicaid Services’ (CMS) release of the “maximum fair prices” for the initial list of ten drugs subject to Medicare drug pricing authority under the Inflation Reduction Act (IRA):
“With the release of the prices for the first list of drugs selected under the Medicare Drug Price Negotiation Program of the IRA, significant market changes are expected not only for the selected drugs but also for their therapeutic alternatives. Advocates have voiced concerns to CMS about potential new access barriers Medicare beneficiaries might face with these medications. They have urged CMS to not only mandate coverage of these drugs but also to limit step therapy, unfavorable formulary placements, and other access hurdles. However, CMS has declined to enforce such protections.
“Many of the drugs on this initial list are used to treat common chronic conditions such as type 2 diabetes, kidney disease, and heart disease. The expected access barriers for Part D beneficiaries are likely to disproportionately affect individuals with these conditions, particularly those with multiple chronic illnesses. Given existing health disparities, underserved populations could experience the greatest negative impact. This will also limit the extent of estimated savings to both the Medicare program and to beneficiaries themselves.
“Consequently, it is highly unlikely that Medicare beneficiaries who depend on these medicines will realize anywhere close to the level of projected savings in out-of-pocket costs that the Administration touted this morning. Savings, wherever they may be ultimately found, must not come at the risk of patient access to medicines that allow them to live longer, healthier lives. Efforts to pass along rebates directly to patients at the pharmacy counter and delink Pharmacy Benefit Manager (PBM) compensation from the list prices of medicines would directly cut costs of medicines for people covered by Medicare and other insurance in a way that IRA price-setting simply cannot.”
For more information on the unintended consequences of the IRA and the resulting challenges posed to chronic disease patients, please visit: www.fightchronicdisease.org/events/AtWhatCost.
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