On August 29, 2023, the Biden-Harris administration announced the first 10 drugs to be negotiated under the Medicare pricing scheme, as per the Inflation Reduction Act (IRA). Half of these medicines are aimed at treating cardiovascular conditions such as heart failure and atrial fibrillation. The action represents a significant stride in increasing access to lifesaving treatments for cardiovascular conditions that afflict millions of older US individuals.
The elderly population, aged 65 and above, has been witnessing an increase in the prevalence of cardiovascular and metabolic diseases. This trend has been a considerable driver in the development of new pharmaceutical treatments. Concurrently, there has been a shift in standard care practices, with newer, high-priced brand-name drugs replacing older, more affordable generics.
The substitution of warfarin with direct oral anticoagulants (DOACs), which are used for preventing stroke in atrial fibrillation patients, is one such instance. While warfarin costs a modest $4 per month, DOACs can range from $378 to $566 monthly. This stark price difference has led to almost a 17-fold increase in Medicare’s annual expenditure on oral anticoagulation therapy, from approximately $440 million in 2011 to an astounding $7.4 billion in 2019.
A similar trend is observed in the evolution of medical treatment guidelines for patients with heart failure with reduced ejection fraction (HFrEF). The former standard treatment included three affordable generic drugs. However, the current standard includes sacubitril/valsartan and a sodium-glucose cotransporter-2 inhibitor, which can cost over $1200 a month, significantly more than the previous regimen that cost as low as $10 a month.
The IRA aims to tackle the escalating medication costs by negotiating prices with drug manufacturers. It is projected that these negotiations will save the government $100 billion from 2026 to 2031. The lower negotiated price will also decrease the out-of-pocket costs for patients. Furthermore, the IRA will require all Part D plans to cover drugs with negotiated prices, thus enhancing access to these medications.
In light of the aging population and the rising prevalence of cardiovascular and metabolic diseases, the Medicare price negotiation can drastically lower the cost of essential medication. The anticipated savings for the government and the reduction in out-of-pocket expenses for patients, coupled with improved access to these drugs, are significant steps towards making healthcare more affordable and accessible for older US residents.
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