News

***MEDIA ADVISORY FOR WEDNESDAY, JUNE 28 AT 2 PM ET***

Inflation Reduction Act Caps Insulin Costs, Expands Access to Life-Saving Vaccines, and Delivers Lower Prescription Drug Prices for Seniors

Lansing, MI — On Wednesday, June 28, at 2 PM ET, Dr. Meena Seshamani, the Deputy Administrator & Director, Center for Medicare, Centers for Medicare & Medicaid Services will join Protect Our Care Michigan and Michigan health care advocates to highlight how seniors in Michigan and across the country are saving on insulin costs, prescription drugs, and life-saving vaccines thanks to the Inflation Reduction Act.

The Inflation Reduction Act is lowering costs and improving health care for millions of Americans, with many critical provisions that provide savings for Medicare beneficiaries. Thanks to the Inflation Reduction Act, insulin copays are capped at $35 per month for more than 3 million diabetics covered by Medicare, including tens of thousands of Michiganders. Additionally, all adults on Medicare Part D have access to covered vaccines, such as shingles and Tdap, at no cost. These policies alone will save seniors in Michigan and across the country hundreds of dollars on their health care costs, keep millions of people healthy, and prevent dangerous complications associated with diabetes, shingles, and other serious diseases.

Speakers will discuss how these provisions are keeping costs low for Michiganders, discuss additional savings to come, and highlight how seniors in the state can access these benefits. The event comes as the Biden administration works to implement the Medicare Drug Price Negotiation Program. By early July, final guidance will be released laying out the rules of the road for how Medicare will select and negotiate lower prices for prescription drugs. The list of the first ten drugs selected for negotiation will be announced by Sept. 1, 2023. With Medicare negotiation for prescription drug prices, the era of Big Pharma being in the driver’s seat is coming to an end.

PRESS CALL:

WHO:
Dr. Meena Seshamani, the Deputy Administrator & Director, Center for Medicare, Centers for Medicare & Medicaid Services
Linda Hamacher, Michigan senior benefitting from the Inflation Reduction Act
Eric Schneidewind, former AARP national president and Michigan health care advocate

WHAT: Virtual Press Conference

WHERE: Register to join the Zoom event (Registration required)

WHEN: Wednesday, June 28, at 2 PM ET

House Package Promotes Junk Plans, Threatens ACA Protections, and Undermines Affordable Health Coverage

Washington, D.C. — Today, House Republicans passed a legislative package that includes several measures to promote junk health insurance plans that undermine patient protections under the Affordable Care Act (ACA) and weaken access to affordable health coverage. The Association Health Plans Act, Self Insurance Protection Act, and CHOICE Arrangement Act all promote insurance plans that remove protections for people with pre-existing conditions and fail to require coverage of essential services like hospital visits and prescription drugs. 

Health reimbursement arrangements (HRAs), similar to health savings accounts, only reward the highest-income workers while worsening racial and ethnic inequities in health care. These bills are especially harmful to communities of color and other marginalized groups who are more likely to face barriers to accessing quality, affordable health care. In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“These bills are part of the Republican war on affordable, quality health care and gut protections for pre-existing conditions and are more about giving tax breaks to the wealthy than helping people get the health care they need. Republicans are once again using their power to strip protections from people with pre-existing conditions and boost insurance company profits. While Republicans are voting on their health care bills – which are widely rejected by the American people, – they oppose legislation that would lower drug prices, make coverage more affordable, and make the health care system fairer for families. Thankfully, President Biden and Democrats are committed to protecting people with pre-existing conditions and putting Americans’ access to quality health care first and can block this legislation in the Senate.” 

Background: 

Read more about the Association Health Plan legislation here.

Big Pharma Enters Attack On Inflation Reduction Act’s Medicare Negotiations

Washington, D.C. – Today, the Pharmaceutical Research and Manufacturers of America (PhRMA) filed a lawsuit to stop Medicare from negotiating for lower drug prices, joining Merck and Bristol Myers Squibb in challenging the constitutionality of the Inflation Reduction Act’s Medicare Prescription Drug Negotiation Program, which allows Medicare to negotiate lower prices for millions of people on Medicare. The authority to negotiate lower prices marks a historic victory against Big Pharma, making prescription drugs more affordable for American patients who pay up to four times more for the same drugs as people in other wealthy countries. 

In response, Protect Our Care Chair Leslie Dach issued a statement:

“Big Pharma’s greed knows no bounds. While Americans are cutting pills and skipping doses, pharmaceutical companies are putting all of their energy into suing the federal government to protect their ability to charge patients outrageous prices to pad their sky-high profits. PhRMA spent record amounts on lobbying to kill the Inflation Reduction Act, and now they are doing everything in their power to stop the law from delivering lower costs to patients. The American people deserve better.” 

Background

Merck Manufactures Pricy Diabetes Drug Likely To Qualify For Negotiation. Merck manufactures Januvia, a type 2 diabetes drug that is likely to be eligible for negotiation and has been on the market without competition for 17 years. In 2021 alone, Medicare spent over $4 billion on the drug. 

Bristol Myers Squibb Manufactures Eliquis, Which is Likely To Qualify For the First Round of Negotiations. Bristol Myers Squibb is motivated to block the Negotiation Program because its blockbuster drug Eliquis is likely to qualify for negotiation. In 2021 alone, Medicare spent over $12.5 billion on the blood clot drug, which is taken by over three million Medicare beneficiaries. BMS is also motivated to block future negotiations over the price of its drugs after announcing that it anticipates several blockbuster drug launches in the near term that could deliver annual sales of $25 billion or more by the end of the decade. 

Big Pharma Will Stop At Nothing To Protect Its Profits. This lawsuit is just the latest salvo in PhRMA’s endless war to protect its profits. In 2022, the pharmaceutical industry spent over $375 million lobbying against efforts to rein in prescription drug costs and tens of millions of dollars more on false and misleading television and online ads trying to defeat the Inflation Reduction Act in Congress.

Biden Administration Continues Rolling Out Savings Through Medicare Drug Price Negotiation

Watch the video here.

Washington, D.C. – Today, Protect Our Care is releasing a new video as part of Lower Prescription Drug Costs Summer. Passed as part of the Inflation Reduction Act, the Biden administration is working to implement the Medicare Drug Price Negotiation Program that will finally give Medicare the authority to negotiate lower prices, making prescription drugs more affordable for millions of seniors and people with disabilities. The summer of 2023 has several key dates as part of the Medicare Drug Price Negotiation Program implementation:

• By early July, final guidance will be released laying out how the selection and negotiation of lower prices for prescription drugs will be done.
• August 16 is the one-year anniversary of the Inflation Reduction Act. 
• By September 1, the ten drugs that are selected for the first round of price negotiations will be announced.

Protect Our Care Director of Policy Programs Andrea Harris issued the following statement:

“The age of Big Pharma’s unchecked power to charge whatever they want for drugs is coming to an end. Thanks to President Biden and Congressional Democrats, Medicare can now negotiate lower prescription drug prices for seniors. By early July, the Biden Administration will begin the process of saving seniors and taxpayers billions of dollars.

“Meanwhile, Big Pharma’s greed knows no bounds as patients in America pay up to four times more for the same drugs as patients in other wealthy countries. Big Pharma is turning to the courts to try to protect their sky-high profits at the expense of patients while their GOP allies in Congress are trying to repeal and weaken the negotiation measure.”

Video Script:

Welcome to Lower Prescription Drug Costs Summer! 

All thanks to President Biden and Congressional Democrats’ achievement of lowering prescription drug costs for seniors through the Inflation Reduction Act. 

This major accomplishment came without a single Republican vote and despite millions of dollars in misleading advertising and lobbying from Big Pharma.

With this new law, the American people won a decades-long battle to finally allow Medicare to negotiate lower drug prices. 

So what’s happening this summer? 

Here are some key dates to keep in mind as the Biden-Harris administration rolls out the new drug law:

• By early July, the administration will release final guidance laying out the rules of the road for selecting and negotiating lower prices for prescription drugs.
• August 16 marks the one-year anniversary of the enactment of the Inflation Reduction Act. 
• And by September 1, the administration will announce which ten drugs are selected for the first round of price negotiations. These will likely be drugs used by millions of seniors to treat conditions like blood clots, type 2 diabetes, arthritis, and cancer.

With Medicare negotiation for prescription drug prices, the era of Big Pharma being in the driver’s seat is coming to an end. 

This progress is particularly important for seniors of color and people with disabilities, who experience health disparities in part because they have more limited access to affordable drugs. 

The new prescription drug law is overwhelmingly popular, yet the pharmaceutical industry is suing to stop it and Republicans in Congress are vowing to repeal it.

But President Biden and Democrats in Congress are more committed than ever to lowering the cost of prescription drugs for all Americans — and that’s why the work we do this summer is so important.

Let’s keep up the momentum so that ALL Americans can afford their medications.

The time to act is now.

Washington, DC — The Republican Study Committee just released a budget proposal that repeals the Inflation Reduction Act’s Medicare negotiation program, hikes premium costs, and slashes Medicaid. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement:

“Republicans are reigniting their war on American health care. This plan hikes prescription drug prices, raises premiums on families, and slashes Medicaid. They want to drag us back to a time when Big Pharma and insurance companies had unchecked power — all at the expense of patients, and particularly seniors, people with disabilities, people of color, and rural Americans. They want to put people’s lives at risk just so the rich can get richer. Some things never change: Republicans want to raise health costs, ditch critical protections, and put profits over patients’ lives. If they get their way, it would be disastrous for the health and well-being of people across our country.”

Washington, DC — Today, the Fifth Circuit Court of Appeals granted a partial stay pending appeal in Braidwood Management v. Becerra, protecting free preventive care for 150 million Americans as the case moves through the courts. In his initial ruling in the case, Judge O’Connor invalidated critical benefits endorsed by the U.S. Preventive Services Task Force, including lifesaving lung, breast, and colorectal cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, intimate partner violence screenings, and access to PrEP (pre-exposure prophylaxis), which can reduce the chance of contracting HIV. The court order, approving an agreement reached by the parties, means that, while the ruling stands for the plaintiffs, it will not go into immediate effect nationwide as Judge O’Connor previously ruled. In response, Protect Our Care Communications Director Anne Shoup issued the following statement: 

“This agreement will protect the 150 million people who rely on preventative services while this case works through the courts. While millions of Americans can breathe a sigh of relief knowing they can continue to access free preventive care, these lifesaving services remain at risk. If Judge O’Connor’s ruling stands, free screenings for depression, diabetes, and heart health will no longer be guaranteed, raising costs on families and threatening the health of millions. Without this guarantee, more Americans will be forced to choose between going to the doctor and paying for other essentials like groceries and rent — meaning more Americans will get sick and more will die of entirely preventable causes.”

This week we highlight the inaugural Centers for Medicare and Medicaid Services (CMS) Health Equity Conference and statements affirming LGBTQI+ health equity. As well, LGBTQI+ advocacy groups, the Black Maternal Health Caucus, and the private sector are pushing forward critical initiatives to accelerate progress to reduce health disparities throughout the country. There are persistent challenges to be overcome, and we have highlighted in particular the growing health crisis in the Southern United States this week. From systemic bias in medicine to political polarization actively harming members of our most marginalized communities, the situation in the U.S. south is dire and must be addressed by local and state leaders.

Protect Our Care is dedicated to making high-quality, affordable and equitable health care a right, and not a privilege, for everyone in America. We advocate for policies that lower health care costs and strengthen coverage, which are critical to expanding access to quality health care and, ultimately, achieving better health outcomes, particularly for people of color, rural Americans, LGBTQI+ individuals, people with disabilities, and more. Our strategies are driven by a broader commitment to tackling systemic inequities that persist due to racism and discrimination and the reality that multi-sector policies are needed to address basic conditions that affect health and related outcomes, particularly for marginalized communities.

INITIATIVES

National Law Review: CMS Holds First Annual National Health Equity Conference. “CMS hosted its inaugural Health Equity Conference on June 7 and 8. The theme of the conference was “Framing the Future of Equitable Health Care” and, as the name suggests, it was an opportunity for CMS leadership to share foundational information and discuss plans for the future. Leaders throughout CMS provided updates on health equity research, discussed promising practices and innovative solutions, and highlighted the value of collaboration across the agency and with the broader community. To that end, the conference also provided a platform for community partners to discuss multiple programs that incorporate equity-focused initiatives.” [National Law Review, 6/9/23]

Department of Health and Human Services: HHS Statements Reaffirm Support for Promoting Health Equity During and After Pride Month. “Every year, during Pride Month, we honor and celebrate the many ways our family, friends, colleagues, neighbors, and fellow Americans in the LGBTQI+ community contribute to the health and wellbeing of our great nation. Today and every day, the Department works to ensure that every American has access to health care – including gender-affirming care – regardless of their sexual orientation or gender identity. We stand with and support Americans who are targeted because of their gender identity and are committed to protecting them. We also stand with and support their parents, caretakers, and families. We will continue to fight on behalf of all Americans to ensure they have access to the care and support they need… Pride is a reminder that until everyone enjoys the full promise of equity, dignity, protection, and freedom, our work is not finished. I am proud to be part of our Administration-wide effort to protect LGBTQI+ Americans from discrimination in health care, including those who need vital behavioral health support.” [HHS, 6/1/23]

Los Angeles Blade: Gilead to Award $5 Million to the HRC’s HIV and Health Equity Programs. “The Human Rights Campaign was awarded a $5 million grant from drugmaker Gilead Sciences to expand the organization’s HIV and health equity programs, supporting efforts to end the HIV epidemic by 2030 while combating stigma in Black and Latino communities. Funds will be used over the next three years for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges & Universities Program, and its Transgender Justice Initiative, HRC said in a statement Wednesday announcing receipt of the award, which extends Gilead’s $3.2 million grant to the HRC Foundation in 2021. The organization said its HIV and Health Equity Program plans to develop a ‘benchmarking tool for institutions that provide HIV services, helping better evaluate the quality of care and measure racially and socially inclusive approaches’ while defining ‘best practices, policies, and procedures to optimize HIV service provision for BIPOC LGBTQ+ communities.’” [Los Angeles Blade, 5/31/23]

America Magazine: Momnibus Has a Chance to Significantly Reduce the Maternal Mortality Rate. “[T]he Catholic Health Association of the United States is strongly advocating for the passage of the Black Maternal Health Momnibus Act. C.H.A. has joined with more than 45 diverse organizations that represent health care providers, public health professionals, researchers, community-based organizations, nonprofits, health insurance providers, hospitals, maternal and infant health advocates, and other key stakeholders in calling on Congress to pass this legislation to address the maternal mortality crisis and eliminate maternal health inequities. Passing the Momnibus Act would begin to address a number of factors that are responsible for the maternal health crisis and its racial inequities, including issues of systemic racism and social risk factors like housing, transportation and environmental conditions. By advancing the Momnibus Act, Congress can make historic investments in high-quality, culturally appropriate maternity care and robust social support. The reintroduction of the Momnibus Act in May yielded a historic number of congressional co-sponsors, demonstrating the importance of this issue.” [America Magazine, 5/30/23]

Healthcare Finance: Groups Including the AMA Launch Movement to Promote Health Equity. “On Tuesday, the American Medical Association, the Institute for Healthcare Improvement (IHI) and Race Forward officially launched Rise to Health, a call to action for providers, payers, pharma and professional societies to make health equity a priority. Rise to Health will have enforcement teeth in the form of establishing a set of measures across numerous participants. Rise to Health: A National Coalition for Equity in Health Care has been in the works for about two years. Its ten founders include the AMA, American Hospital Association and AHIP. A unified strategy is the most effective way to create meaningful change, said AMA president Dr. Jack Resneck Jr. Prior efforts have been in siloes, said Mate, who has been working with coalition members around the founding principle that healthcare quality is inseparable from health equity. The coalition has seen dozens of providers, pharma companies and payers add equity to their strategic plans, Mate said. Specific actions defined by the coalition include: a commitment to acting for equity, getting grounded in history and the local context, identifying opportunities for improvement, making equity a strategic priority, taking on initiatives, and aligning, investing and advocating for thriving communities.” [Healthcare Finance, 5/31/23]

CHALLENGES

U.S. News: Southern States Refusing to Expand Medicaid Perpetuates Racism According to Data. “While 40 states have expanded Medicaid, 10 states have not – and most of those are in the South. This refusal to enact Medicaid expansion amounts to a refusal to ease the health care burden of some 3.5 million uninsured adults. People want health insurance, and polling shows 57% of U.S. adults believe the federal government should be tasked with providing health care for all Americans. Of the 10 states that have not expanded Medicaid, seven are in the South: Alabama, Georgia, Florida, Mississippi, South Carolina, Tennessee and Texas. Ironically, Southern states are some of the hardest hit by interrelated issues like poverty, poor health care access and health disparities. Southern states are also home to some of the largest Black populations in the U.S., highlighting how expanding Medicaid in the South is clearly an issue of racial justice. In fact, according to a March analysis from KFF, more than 6 in 10 nonelderly adults who fall into the national coverage gap – meaning they live in a state that has not adopted Medicaid expansion and are not eligible for coverage through the program or for subsidies through the Affordable Care Act’s marketplaces – are people of color. Nearly all nonelderly adults in this coverage gap live in the South. A similar case in point: If Mississippi expanded Medicaid, KFF data has shown Black and Hispanic people accounted for 55% of the uninsured adults who would be newly eligible for coverage, with whites accounting for 42%. This would be crucial for children and adults in the state, which is home to the nation’s highest rate of infant mortality, according to data from the Centers for Disease Control and Prevention.” [U.S. News, 6/7/23]

KFF Health News: There is a Stark Disparity Between Black and White Infant Mortality in the South. “By 2030, the federal government wants infant mortality to fall to 5 or fewer deaths per 1,000 live births. According to annual data compiled by the Centers for Disease Control and Prevention, 16 states have already met or surpassed that goal, including Nevada, New York, and California. But none of those states are in the South, where infant mortality is by far the highest in the country, with Mississippi’s rate of 8.12 deaths per 1,000 live births ranking worst. Even in those few Southern states where infant mortality rates are inching closer to the national average, the gap between death rates of Black and white babies is vast. In Florida and North Carolina, for example, the Black infant mortality rate is more than twice as high as it is for white babies. A new study published in JAMA found that over two decades Black people in the U.S. experienced more than 1.6 million excess deaths and 80 million years of life lost because of increased mortality risk relative to white Americans. The study also found that infants and older Black Americans bear the brunt of excess deaths and years lost. Some experts believe expanding Medicaid coverage to single, working adults who aren’t pregnant and don’t have children — something most Southern states have failed to do — would also help curtail infant deaths. A woman who is healthy when heading into pregnancy is more likely to give birth to a healthy baby because the health of the mother correlates to the health of the infant. Birth outcomes experts agreed that racism and poverty lie at the heart of this difficult problem, which disproportionately threatens Black infants and mothers in the rural South. Research shows that white doctors are often prejudiced against Black patients and minimize their concerns and pain. In South Carolina, the maternal mortality rate increased by nearly 10% from 2018 to 2019, according to the latest data, which found that the risk of pregnancy-related death for Black mothers was 67% higher than for white mothers. Upon review, the state health department determined 80% of those pregnancy-related deaths were preventable.” [KFF Health News, 5/22/23]

AP: Doctors Not Taking Black Women Seriously is a Major Component of Maternal Mortality Racial Disparities. “Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention. Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives. To be Black anywhere in America is to experience higher rates of chronic ailments like asthma, diabetes, high blood pressure, Alzheimer’s and, most recently, COVID-19. Black Americans have less access to adequate medical care; their life expectancy is shorter. Black Americans’ health issues have long been ascribed to genetics or behavior, when in actuality, an array of circumstances linked to racism — among them, restrictions on where people could live and historical lack of access to care — play major roles. Discrimination and bias in hospital settings have been disastrous. Maternal sepsis is a leading cause of maternal mortality in America. Sepsis in its early stages can mirror common pregnancy symptoms, so it can be hard to diagnose. Due to a lack of training, some medical providers don’t know what to look for. But slow or missed diagnoses are also the result of bias, structural racism in medicine and inattentive care that leads to patients, particularly Black women, not being heard. For decades, frustrated birth advocates and medical professionals have tried to sound an alarm about the ways medicine has failed Black women. Historians trace that maltreatment to racist medical practices that Black people endured amid and after slavery. To fully understand maternal mortality and infant mortality crises for Black women and babies, the nation must first reckon with the dark history of how gynecology began, said Deirdre Cooper Owens, a historian and author.” [AP, 5/23/23]

 Biden Administration Announced Lower Out-of-Pocket Costs for 43 Drugs Subject to Penalties 

Washington, DC — Today, the Biden administration announced that the number of drugs subject to the Inflation Reduction Act’s inflation penalties has doubled. This means that 43 prescription drugs had price hikes outpacing the annual rate of inflation last quarter, and now these drug manufacturers must pay Medicare a rebate and Medicare beneficiaries will see lower coinsurance costs. According to CMS, beneficiaries could save up to $449 per dose on these drugs. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“This announcement is an important reminder that the Inflation Reduction Act is working for the American people. Drug companies are finally being held accountable when they jack up the price of prescription drugs in order to pad their profits. For years, seniors from all backgrounds have faced prescription drug prices that rise so fast they can’t keep up, and too many have been forced to choose between buying food or prescription drugs that keep them alive. Now, seniors purchasing some of the most expensive medications can breathe a sigh of relief knowing that greedy drug companies are being held accountable by the Biden administration.”

Washington, D.C. — Today, the Supreme Court of the United States issued a ruling to protect over 90 million Americans who receive their health care through Medicaid. Health and Hospital Corporation of Marion County v. Talevski, which was described as “one of the most consequential health care cases in [the Supreme Court’s] history,” concerns whether individuals have the right to enforce provisions of the Medicaid law in court. The Court upheld individual’s right to sue, supporting decades of precedent and protecting patients’ access to critical health care coverage. An adverse ruling in this case would have also implicated the rights of beneficiaries across a broad range of state-administered public programs, including Supplemental Nutrition Assistance Program, child welfare, and federal public housing benefits. In response, Protect Our Care’s Policy and Health Equity Senior Advisor Anne Morris Reid issued the following statement:

“A negative ruling in this case would have been devastating  for the tens of millions of Americans who rely on Medicaid for their health coverage – with particularly severe consequences for the pregnant women, children, people of color, people with disabilities and other low-income Americans this program serves. The Supreme Court rejected the defendants’ goal to strip patients of their rights to seek targeted and rapid relief when they lose or are denied health coverage. At a time when Republicans are playing politics with Medicaid as part of their ongoing war on health care, it is a relief that the Court’s decision protected the most powerful tools beneficiaries have to hold state officials or health providers accountable.”