Radar on Drug Benefits

More than 1.4 million Medicare beneficiaries could see their medication costs plunge if the Senate passes a budget reconciliation bill that contains drug pricing reforms, Kaiser Family Foundation estimated.

The bill — put forward by Senate Majority Leader Chuck Schumer (D-N.Y.) and Sen. Joe Manchin III (D-W.Va.) — will allow Medicare to negotiate some prescription drug prices starting in 2026 and require drug companies to pay rebates if drug prices rise faster than inflation starting in 2023. Between 2019 and 2020, half of drugs covered by Medicare Part D and 48% of drugs covered by Medicare Part B saw price increases greater than the rate of inflation (1.0%), according to a previous Kaiser Family Foundation analysis.

With abortion banned or on the verge of a ban in a growing number of states following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, medication abortion has become more important than ever for women and pregnant people seeking abortion care. Abortifacients, the class of prescription drug used to terminate pregnancies, can be used more discreetly than surgical abortions: they don’t require an in-person consultation and, since the start of the pandemic, have been dispensed online without medical risk to patients. 

However, experts say that the legal status of medication abortion is far from settled in states where abortion has been banned. Many patients haven’t heard that medication abortion is available, and women and pregnant people who do use abortifacients — or suffer a miscarriage — could face prosecution in states where abortion has been banned. It’s not clear what sort of criminal or civil risk providers, purchasers and carriers will bear if their patients and plan members use abortifacients prescribed across state lines. 

UnitedHealth Group announced on July 15 that it would eliminate out-of-pocket costs for insulin and a few other medications for beneficiaries enrolled in fully insured plans. The managed care organization expects to implement the changes starting as early as Jan. 1, 2023, pending regulatory approval. 

Health and drug policy experts who spoke with AIS Health, a division of MMIT, applauded UnitedHealth’s decision, and noted it would benefit patients who struggle to pay for medications and increase adherence. They also said the move could help United financially, as members are more likely to stay out of the hospital and have better long-term health, but they said it could lead to higher premiums for employers and employees. UnitedHealth did not respond to AIS Health’s request for comment on how the company would foot the bill for implementing the zero cost-share policy. 

Pharmacists and other non-physician care managers can improve the quality of diabetes care in the primary care setting, but structural issues make it difficult to fully leverage their potential, according to research published in the July issue of the journal Health Affairs.  

“We need to have a different way of taking care of people with a chronic illness,” said Thomas Bodenheimer, a professor emeritus of family and community medicine at the University of California, San Francisco, who spoke at a Health Affairs briefing on July 19. The briefing convened several researchers who published diabetes-focused articles in the journal’s July issue.