WASHINGTON — The Biden administration is taking a victory lap after federal officials inked deals with drug companies to lower the price for 10 of Medicare’s most popular and costliest drugs, but shared few immediate details about the new price older Americans will pay when they fill those prescriptions. White House officials said Wednesday night they expect U.S.
taxpayers to save $6 billion on the new prices, while older Americans could save roughly $1.5 billion on their medications. Those projections, however, were based on dated estimates and the administration shared no details as to how they arrived at the figures.
Nonetheless, the newly negotiated prices — still elusive to the public as of early Thursday morning — will impact the price of drugs used by millions of older Americans to help manage diabetes, blood cancers and prevent heart failure or blood clots. President Joe Biden leaves after speaking about prescription drug costs in December at the National Institutes of Health in Bethesda, Md. The drugs include the blood thinners Xarelto and Eliquis and diabetes drugs Jardiance and Januvia.
Medicare spent $50 billion covering the drugs last year. It's a landmark deal for the Medicare program, which provides health care coverage for more than 67 million older and disabled Americans. For decades, the federal government had been barred from bartering with pharmaceutical companies over the price of their drugs, even though it's a routine process for private insurers.
“This meant that drug companies could basically charge whatever they want for life-saving treatments people rely on, and all Americans paid the price,” White House adviser Neera Tanden told reporters in a Wednesday night call. The drug deals will become a focal point for Vice President Kamala Harris’ presidential campaign, especially since she cast the tie-breaking vote to pass the law. She will join President Joe Biden Thursday to announce the drug prices, their first joint speaking appearance since she replaced him at the top of the Democratic ticket, as they both struggle to convince voters that costs will trend down after years of above-normal inflation.
The pair last appeared publicly together to welcome back to the U.S. Americans detained in Russia who were freed as part of a massive prisoner swap earlier this month.
Powerful pharmaceutical companies unsuccessfully tried to file lawsuits to stop the negotiations, which became law in 2022, when a Democratic-controlled Congress passed the Inflation Reduction Act, overhauling several Medicare prescription drug regulations. But executives of those companies have also hinted in recent weeks during earnings calls that they don't expect the negotiations to impact their bottom line. The Centers for Medicare and Medicaid Services, which oversaw the dealmaking, is expected to release the final drug prices later Thursday.
The new prices won't go into effect until 2026. Next year, the Department of Health and Human Services can select another 15 drugs for price negotiations. Before the drug prices were finalized, the Congressional Budget Office estimated the negotiations could save the federal government $25 billion in 2031.
The official event comes a day before Harris is set to unveil part of her economic agenda on Friday in North Carolina, where she was aiming to roll out other ways she plans to help cut costs and boost incomes for the middle class. Family therapists and mental health counselors can bill Medicare directly due to the reforms implemented this year. CMS will temporarily add health and well-being coaches to covered services under its Medicare Telehealth Services list this year.
It's also expanding the health care providers that provide covered behavioral health assessments to provide better physical care. It will begin allowing addiction, drug, and alcohol counselors who meet certain requirements to enroll as mental health counselors under Medicare. CMS also plans to add a rule this year that allows health providers to pay for caregiver training through Medicare, hoping to expand and enhance the existing caregiving industry.
This year, CMS will reduce requirements for nurse practitioners, allowing them to provide behavioral health services at rural health clinics and federally qualified health centers. Previously, they had to have certification in providing primary care, but CMS is removing the barrier in order to alleviate staffing shortages. It will also allow those clinics to continue providing telehealth services.
As part of its expansion of COVID-era telehealth policies, CMS is also extending a temporary rule that allows Opioid Treatment Programs to bill Medicare for assessments of patients conducted over the phone or online using audio only and no video. With this move, CMS hopes to avoid disruptions to existing access Medicare recipients have to opioid treatment. Medicare will now allow for the reimbursement of services from more health care specialists, expanding the possible avenues for treatment in places where they might be hard to find.
The new reforms specifically include peer support specialists and community health workers . Peer support specialists help others avoid relapse and maintain their recovery process, a relationship informed by the specialist's lived experiences with conditions like substance use disorder. Community health workers help connect the health care system with the communities they serve.
CHWs work at nonprofits, government agencies, public health departments, and community programs. They can perform educational outreach, counseling, or help people find transportation to appointments. These kinds of workers were integral to the public health response to the COVID-19 pandemic: Studies found CHWs offer support for geriatric patients with complex needs , according to a research review published in a 2022 issue of the Journal of the American Geriatrics Society.
Some states were already making rules to allow for coverage of CHW services, and new Medicaid rules may also expand the number of working CHWs around the country as funding for them is bolstered. Story editing by Alizah Salario. Copy editing by Kristen Wegrzyn.
Photo selection by Lacy Kerrick. This story originally appeared on Foothold Technology and was produced and distributed in partnership with Stacker Studio. Sign up here to get the latest health & fitness updates in your inbox every week!.
