Recently, President Biden and his party in Washington celebrated the passage of the climate and drug pricing law. While most of the fanfare focused on how important lowering costs in health care is, the bill actually does very little to fix our broken system.
There is no doubt that lowering out of pocket costs is an admirable goal. But trading off new and future medicines for the promise of just a few lower prices is not a risk some of us are willing to take.
I’ve lived in the Las Vegas Valley for over three decades. I can recall countless campaign promises and ads over the years on the importance of lowering health related costs for patients and families. On that, everyone can agree. That’s why it was refreshing to think “something” was really going to be done about healthcare high costs with the passage of the Inflation Reduction Act.
However, the legislation allowed marketplace brokers, insurance companies, PBMs and other financial culprits completely off the hook. Instead of helping everyone, lawmakers chose to usurp a key part of Medicare to set the prices of a select few medications. This policy, called “Medicare negotiation,” could mean fewer new medicines reach the market in the next few years, posing a serious threat to a patient’s access to care.
For anyone who lives with health complications, access to care is an issue far from trivial. In 2017, I was diagnosed with sleep apnea. It led to a number of other serious health complications. It took me critical months to land on the optimal prescriptions, and my quality of life, health, and wellbeing depended on it. It’s the same for so many other people living with chronic conditions.
It takes continuous, innovative research and resources to find the right medicines and cures for all types of conditions, not less. Congress’ efforts would have been better spent “going after the players in the system” who are more concerned about bottom lines than better outcomes for patients waiting on a cure.
Two areas did not get addressed, namely pharmacy benefit managers (PBMs) and insurance company evaluation. First, PBMs have been pocketing savings meant for patient for too long. It is estimated that 80 percent of the PBM market share is controlled by just three companies. Those companies determine what medications insurance companies will cover and how much patients will have to pay the pharmacy. Astonishingly, the Inflation Reduction Act healthcare provisions do nothing to address these PBMs or rebates that should be making it into the pockets of patients.
The second area not addressed in this bill is insurance company oversight. Why this was not a priority for Washington lawmakers to examine denial of treatments or limiting coverage arbitrarily makes no sense.
This bill was clearly rushed. It’s unfortunate that the most vulnerable patients, who politicians claimed they were trying to help, won’t feel relief. In future healthcare votes, our leaders should focus to leave no patient behind.
- The Inflation Reduction Act’s Blind Spot On Health Care - October 19, 2022