Since its enactment in 2010, the Affordable Care Act has undergone various refinements. A recent example stems from the passage of the Inflation Reduction Act (P.L. 117-169) that President Biden signed into law on August 16, 2022. One of its features is that Medicare will be able to negotiate drug prices starting in 2026. Nearly 20 years after the creation of the Medicare Part D program, the Centers for Medicare & Medicaid Services (CMS) will be able to negotiate drug prices directly with manufacturers. Thus far, the Congressional Budget Office (CBO) has estimated the total savings achieved each year for negotiation, but has not publicly identified the drugs anticipated to be negotiated. The March 2023 issue of the Journal of Managed Care+Specialty Pharmacy (JMCP) contains an article regarding drugs that are likely subject to Medicare negotiation.
Medicare will be able to negotiate drug prices starting in 2026. By 2028, prices for 38 drugs dispensed in pharmacies and two drugs provided in physician offices will be negotiated. Medicare drug price negotiation will benefit patients with common diseases, such as diabetes, cancer, respiratory conditions, or cardiovascular disease. Combined, the 40 products eligible for negotiation in 2026-2028 accounted for $67.4 billion in gross Medicare spending in 2020. Part D drugs eligible for negotiation in 2026-2028 include seven inhalers, eight antidiabetics, five kinase inhibitors, and three oral anticoagulants. In all but five cases, high-spend drugs ineligible for negotiation were disqualified because of generic or biosimilar competition. By generating the list of drugs likely subject to Medicare negotiation in the initial years, the Journal article authors hope to provide researchers, policymakers, prescribers, and patient advocates with expectations on which drugs are expected to see reductions in beneficiary cost sharing.
Consumer Adoption Of Digital Health
Based on a new survey released by Rock Health, a non-profit venture fund, and Stanford University’s Center for Digital Health, most U.S. adults prefer obtaining prescription refills and care for minor illnesses via telemedicine rather than in-person care. Since 2015, Rock Health annually has surveyed a U.S. Census-matched sample of adults to check the pulse on consumers’ attitudes toward and behaviors surrounding digital health. Respondents used their personal desktop, laptop, smartphone, or tablet to complete the survey in English. The 2022 study of more than 8,000 adults found that approximately two-thirds of Americans prefer in-person care for visits related to chronic conditions and mental health, while three-quarters of adults prefer in-person visits for annual wellness checks, emergency care, and physical therapy.
In the 2022 Survey, 80% of all respondents reported having accessed care via telemedicine at some point in their lives, an increase of eight percentage points from 2021. While telemedicine use continues to vary across demographic segments, 2022 saw notable adoption increases among groups that have long been underserved in health care. The greatest year-over-year increases were observed among respondents aged 55+ (76%, up from 64%), respondents living in rural areas (73%, up from 60%), and respondents without health insurance at the time of the survey (50%, up from 37%). Telemedicine use also increased among women, with 82% of respondents reporting having used telemedicine (a 9% increase from 2021). Eighty-two percent of Hispanic respondents reported telemedicine use, reflecting a 9% increase since 2021, the greatest percentage point increase among all racial and ethnic groups captured by the Survey.
Protecting Beneficiaries From “Junk” Health Plan Coverage
A group of Senate Democrats sent a letter to Department of Health and Human Services Secretary Xavier Becerra on February 22, 2022 urging the administration to take immediate action to address the availability of short-term, limited duration health insurance plans that violate the Affordable Care Act. The letter expresses concerns about individuals who will lose Medicaid coverage gained during the COVID-19 pandemic as state programs begin their redetermination processes. Beginning in April 2023, millions of Americans are at risk of losing Medicaid coverage that they have relied upon during the COVID-19 pandemic. Without additional protections they could find themselves enrolled in “junk” plans that do not provide comprehensive coverage or protection for individuals with pre-existing conditions. Steps also must be taken to ensure that these plans are not allowed to proliferate further.