BLOG: Washington to the rescue? Congress passes a drug cost bill
Click Here to Manage Email Alerts
This is a dry eye disease blog. From time immemorial, we have struggled with the out-of-pocket costs of the drugs we prescribe. All of those drugs enjoyed patent protection, allowing the manufacturers to control prices.
Once upon a time, brand drug prices were kinda like electronics; the older they were, the more their price decreased. This changed some time around 2010, and list prices began to climb. The prime example in the dry eye disease (DED) world was Restasis (cyclosporine ophthalmic emulsion 0.05%). Allergan embarked on a twice-a-year schedule of price increases that lasted for years.
U.S. citizens have been inundated with hard-to-understand data on drug “costs” for several years. We are told that “costs” are going down, and yet, in the office, we hear that costs for our patients are going up. The explanation? Your patient’s costs are driven by the price of the medicine, and rising prices mean higher out-of-pocket costs. When you read that “costs” are going down, you are reading about the amount of money spent by the insurance company, not your patient.
Recently, Congress passed, and the president signed, a crazy mishmash of a bill that covered stuff from infrastructure to climate change mitigation, in addition to “relief” from high drug costs. From what I can see, the only immediate relief will be for patients who take insulin. There is now a $35 cap on the monthly out-of-pocket expense for insulin. Unless you read below the headline, you miss the part about this bill being little more than a pre-election promise: Every other potential relief is the proverbial can kicked down the sidewalk.
You know, like Wimpy: “I’ll gladly pay you Tuesday for a hamburger today.”
No real relief comes until 2025, when annual out-of-pocket drug costs are capped at $2,000 per year. Does this mean the end of the notorious “donut hole” that kicks in after a certain amount of money is spent on drugs? No idea. There is no mention of the donut hole and, for that matter, no mention of other deductibles and how they may apply. In 2026, Medicare will have the ability to negotiate prices for a total of 10 branded drugs.
Why talk about this now? Your patients will have read the headlines, and they are going to expect cost relief today. You’ll need to be ready to address that. None of your prescriptions are going to be in those 10 drugs that will be subject to negotiation. Sorry. The cynic in me recognizes the hype about the bill is coming before the midterm elections, but the lawsuits about whether it passes legal muster won’t come until after.
So, did Washington save the day? Hardly. None of it may ever come to pass. The only thing you can hope for is that Mark Cuban gets diagnosed with DED and discovers how much immunomodulators cost.
Collapse