AARP Tele-Town Hall on the Fight to Lower Prescription Drug Costs

Bill Walsh: Hello. I am AARP Vice President Bill Walsh and I want to welcome you to this important discussion about AARP's fight to lower prescription drug prices. Before we begin, if you'd like to hear this telephone town hall in Spanish, press *0 on your telephone keypad now.

AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. And for much of that time, AARP has been fighting hard on behalf of older adults to lower prescription drug costs. And we've won a significant victory. A law passed in August will help millions of older adults save money on their medications after years of paying the highest prices in the world. While this victory is sweet, the fight isn't over. AARP will continue to fight to ensure the law is implemented and continue to advocate for additional measures to make prescription drugs affordable.

Today we'll hear from impressive panel experts about this historic win and what it means for you. We also get an update from Capitol Hill on this legislation and what AARP is doing to continue the fight to lower prescription drug prices. If you've participated in one of our Tele-Town Halls in the past, you know this is similar to a radio talk show, and you have the opportunity to ask your questions live. For those of you joining us on the phone, if you'd like to ask a question about the fight to lower prescription drug prices, press *3 on your telephone keypad. You'll be connected with an AARP staff member who will note your name and question and place you in a queue to ask that question live. If you're joining us on Facebook or YouTube, you can drop your question in the comments section.

Hello, if you're just joining, I'm Bill Walsh with AARP and I want to welcome you to this important discussion about the fight to lower prescription drug prices. We're talking with leading experts and taking your questions live. To ask your question, please press *3 on your telephone keypad, and if you're joining on Facebook or YouTube, drop your question in the comments section.

We have some outstanding guests joining us, including a public health policy specialist and an expert on prescription drug pricing and coverage. We'll also be joined by my AARP colleague Jesse Salinas, who will help facilitate your calls today. This event is being recorded and you can access the recording at aarp.org/coronavirus 24 hours after we wrap up. Again, to ask your question, please press *3 at any time on your telephone keypad to be connected with an AARP staff member, and if you're joining on Facebook or YouTube, drop your question into the comments section.

Now I'd like to welcome our guests. Leigh Purvis is the director of Healthcare Cost and Access at AARP. Welcome to the program, Leigh.

Leigh Purvis: Thank you so much for having me.

Bill Walsh: All right, thanks so much for being with us. Leigh is joined by David Mitchell. David is the president and founder of the nonprofit group Patients for Affordable Drugs, which advocates for lower prescription drug prices. Welcome, David.

David Mitchell: Bill, thank you very much. Glad to be here.

Bill Walsh: All right. We're delighted to have both of you. And just a reminder to our listeners, to ask your question, press *3 on your telephone keypad or drop it in the comments section on Facebook or YouTube.

All right. Let's get started. Leigh, efforts to allow Medicare to negotiate prices have been going on for decades. Why is this so important for AARP and for consumers?

Leigh Purvis: Yeah, AARP has been advocating for Medicare negotiation for almost 20 years now, which is kind of amazing to say out loud. Our perspective has always been that it makes absolutely no sense for the Medicare program and its more than 60 million beneficiaries to be stuck paying prescription drug prices that are largely based on what the market will bear. Now in Medicare's prescription drug benefit, or Part D, was created nearly two decades ago. The bill explicitly said that Medicare could not negotiate with drug companies. Some Part D plans were able to negotiate on behalf of their enrollees, so there was some price negotiation taking place, but even the biggest prescription drug plans do not have the same clout as Medicare when it's negotiating on behalf of everyone in the program. And that is why AARP has been pushing so hard for Medicare negotiation. The program will have an incredible amount of power at the bargaining table, and that will lead to a much better deal for Medicare beneficiaries and the taxpayers who help fund the program.

Bill Walsh: Thanks for that. Leigh, now can you provide some examples of drugs that could be included in the negotiations?

Leigh Purvis: Sure, and just to be clear there are some limits on which drugs can be eligible for negotiation. For example, all of the drugs have to be single source, meaning there's no generic competition on the market. And the newest drugs on the market will not be eligible for negotiation. The drugs will also, the drugs that will be eligible for negotiation will only be entered into kind of the system if it's been a certain number of years since they were approved by the U.S. Food and Drug Administration. So some very high-spend drugs that currently meet those thresholds include drugs like Eliquis, which is a very common blood thinner; Genovia, which is used to treat diabetes; and XTANDI on drugs that are used to treat cancer. Some other drugs we've been eyeing that don't currently meet the threshold but could meet them by the time negotiation really kicks off include drugs like Imbruvica, which is for cancer; Jardiance, which is for diabetes; and Eylea, which is for age-related macular degeneration. So really looking at a very broad number and type of drugs that could be eligible for negotiation in the near future.

Bill Walsh: Yeah. And those names, those are probably pretty familiar to people who watch all of the ads on TV. So I imagine they are drugs taken by millions of people across the country. Leigh, of course the prescription drug benefits are embedded in the law called the Inflation Reduction Act of 2022. Which provisions of that act are going to matter most to Medicare beneficiaries?

Leigh Purvis: So first and foremost, I would probably have to say, as I just mentioned, Medicare negotiations. There's also a new $2,000 annual out-of-pocket limit for people in prescription drug plans. And there are also penalties for drug companies that increase their prices faster than inflation. And something else has caught a lot of attention is the new monthly copay caps for insulin of $35 that will help millions of Medicare beneficiaries. This is a really important mix of provisions that will address those high out-of-pocket costs and the higher prescription drug prices that are driving them. But I don't want to leave anything behind. This is like choosing your favorite child. So there are a lot of other provisions that I think will help as well. For example, starting next year recommended vaccines will be available at no cost in Medicare. This includes vaccines like shingles, which we know can cost upwards of $300 out of pocket. So that is a real meaningful change for people who perhaps have been hesitant to pay for that vaccine. We also know that a lot more people are going to be eligible for Medicare's extra-help program, which can significantly reduce your prescription drug related costs and premiums. And people in Medicare prescription drug plans will also be able to smooth their cost sharing over the entire year, rather than face really high costs over a short period of time. So another way of looking at it is there really is something in there for pretty much everyone.

Bill Walsh: That's great. Thanks so much, Leigh. And we're going to touch, we're going to dig into some of those provisions later on in the program, but let me turn to our next guest, David Mitchell. Don't private insurers and the Veterans Administration negotiate prices with drugmakers now? How is that different or the same from what Medicare will be doing?

David Mitchell: Well, Medicare is the largest purchaser of drugs in the U.S. And as Leigh pointed out, until now it's been prohibited expressly from using that purchasing power to get a better deal for Americans. And the approach that will be taken in the negotiations is somewhat different from what private insurers and the Veterans Administration does, they use a different structure for the negotiations. This new law will set up a process that seeks to lower the prices of old drugs that should have competition, but don't, and that are costing patients and taxpayers an inordinate amount of money. And so the structure for the negotiation, the targets for negotiation are somewhat different. But importantly, the drug companies wanted nothing to do with any of this. They got that prohibition on Medicare negotiating directly with drug companies back in 2003, and they have been lobbying, Leigh pointed out, AARP has been fighting this fight for almost 20 years. They've been spending — the drug companies — hundreds of millions of dollars on lobbying and campaign contributions to keep that prohibition so they could continue to dictate the prices of brand-name drugs to the American people. Well, this year the American people rose up and said enough. AARP took the lead in fighting to get this legislation passed and now we will, in fact, be able to bring that negotiating power of Medicare to bear for millions of Americans.

Bill Walsh: All right. That's great to hear. David Leigh was talking about some of the particular benefits. I want to ask you about them as well. What about people who have cancer or other life-threatening conditions? How does this legislation impact them?

David Mitchell: Yep, well, I'm one of those people, Bill. I have an incurable blood cancer. It's called multiple myeloma, and right now my doctors have me on a four-drug combination that carries a list price of more than $900,000 a year. Now I'm very grateful for these drugs, they're keeping me alive, literally, but they're wildly overpriced, and they're overpriced because the drug companies use all sorts of tactics to block competition, to extend their monopolies, the exact abusive behaviors that this legislation — by attacking these drugs that have been on the market for a long time, that should have competition, but don't — aims to address. Just one of my drugs under Medicare Part D, an oral drug, a chemo drug, costs me more than $16,000 a year out of pocket. Now Leigh pointed out that for the first time ever there is going to be an out-of-pocket cap for Medicare beneficiaries at $2,000 a year. This is going to be transformative for me and millions of other cancer patients over time because instead of being at the mercy of no out-of-pocket cap that can lead to my, you know, as much as I'm paying more than $16,000 a year, all of a sudden that's going to come down when the law fully takes effect to $2,000. This is a big deal. And the inflation limits on price increases will affect all of us by holding the line and stopping price gouging by the drug companies.

Bill Walsh: Yeah, well that's tremendous. That's a real-world impact that's going to not just benefit you, David, but millions of people on Medicare. Thanks for that. And as a reminder to our listeners, to ask your question of our expert panel, please go ahead and press *3 on your telephone, keypad, and we're going to get to those live questions shortly. But before we do, I want to bring in Megan O'Reilly. Megan is the vice president of Health and Family Advocacy at AARP, and she's going to update our listeners about how AARP is fighting for them on Capitol Hill. Welcome, Megan.

Megan O'Reilly: Happy to be here, Bill.

Bill Walsh: First of all, congratulations to AARP as well as the many AARP volunteers and members across the country who fought so hard over so many years to make lower drug prices a reality.

Megan O'Reilly: Thank you. You know, we are thrilled with the passage of this historic legislation, which is really a victory for all older Americans. After decades of calling on Congress to make prescription drugs more affordable, AARP has won the fight for Medicare to negotiate lower drug prices and help seniors save money on their medications.

Bill Walsh: All right. Now, going back to the beginning, why is AARP involved in the fight to lower prescription drug prices?

Megan O'Reilly: One of the things we hear from most, from our members, is that frustration and desperation that comes from trying to afford the skyrocketing prices of prescription drugs. The most common reason that older people skip medications or ration their medications is because they can't afford it and letting Medicare to negotiate for lower drug prices is a common-sense solution. It will strengthen Medicare and, together with the new out-of-pocket cap in Part D, put money back in the pockets and at the same time for seniors that are struggling to afford the rising costs of medications and other basic needs.

Bill Walsh: Okay. And as I mentioned before, we're specifically talking about the Inflation Reduction Act of 2022, which was passed by both the House and the Senate, and then signed into law on Aug. 16th. What are some of the important items included in this bill that AARP fought to make a reality?

Megan O'Reilly: Both Leigh and David have hit on some of that but let me just go through this for you once again. The legislation is going to allow Medicare to negotiate for the first time some of those drugs with the highest cost prices that millions of Americans, millions of seniors are taking. The bill is also, beginning in 2025 as we've talked about, going to put a hard $2,000 limit on how much a senior in Part D will have to pay out of pocket for their medications. And it's going to penalize drugmakers that increase those prices faster than the rate of inflation starting this year. And finally, the new law caps the cost of Medicare-covered insulin at $35 a month and eliminates out-of-pocket costs for most vaccines, such as shingles, under Medicare. This bill will save seniors and Medicare hundreds of billions of dollars and give seniors peace of mind knowing that there is an annual limit on what they must pay out of pocket for medications.

Bill Walsh: Okay, Megan, I mean, those are, those are a lot of provisions. Can you talk about when consumers will see some of these changes taking place?

Megan O'Reilly: Sure. There's some that will be immediate and there's some that will take a few years to implement. So later this year, drug companies that increase the prices of their products faster than the rate of inflation will have to start paying back rebates, penalties to the government. At start of next year, copays for insulin and Medicare will be capped at $35, and people on Medicare will no longer have to pay for any recommended vaccine, like I mentioned, shingles. Other improvements will save seniors and Medicare money like caps on out-of-pocket payments in Part D and requiring Medicare to negotiate. That will take effect in the years that follow.

Bill Walsh: Okay, well, that's all great news. This is a historic win. What's next for AARP?

Megan O'Reilly: This is a huge victory, but as you've said, the fight is not over. We know big drug companies will spend millions trying to overturn or undermine the new law so that they can keep charging Americans the highest prices in the world. AARP will keep fighting big drug companies' out-of-control prices, and we will not back down. Our top priority is to see these changes implemented and to do more to ensure that seniors can afford their medications.

Bill Walsh: All right. Well, that's great to hear. Megan, maybe you can talk about some of the other health priorities AARP is fighting for.

Megan O'Reilly: AARP is fighting for many ways to protect the health of older Americans. Right now, we're fighting for help for family caregivers and working to provide seniors with greater access to home care and more nursing home protections. We're also fighting for dental coverage in Medicare. We've successfully weighed in with the Centers for Medicare and Medicaid Services to expand when Medicare will cover dental care when it's tied to another health condition covered by the Medicare program. And we're going to continue to advocate for broader dental coverage, as well as hearing and vision care. We've advocated for the new over-the-counter hearing aid rule that was released last month. Lower-cost hearing aids will now be available for those of you with low to moderate hearing loss, starting in October. This comes after years of AARP's bipartisan work with Congress and the administration to expand access to lower-cost hearing aids. We're also continuing to fight to allow greater use of telehealth, working to solve senior hunger and food insecurity, we're advocating on mental health coverage, and fighting to expand access to affordable health care. AARP is fighting hard to improve your health care and quality of life.

Bill Walsh: All right, Megan. Thanks. That's a lot of important work and of course AARP couldn't do it without its millions of members and volunteers working with AARP and on its behalf, so congratulations to everybody involved in what I know has been a decades' long fight to make this happen. Megan, finally, if our listeners want to stay on top of AARP's advocacy news, how can they find out the latest updates?

Megan O'Reilly: Sure, we would encourage everyone to go online and search AARP Fighting for You. That will lead you to a daily roundup of all the latest advocacy news and updates on our work with Congress and across the country. It's really a great way to stay informed, and we hope that you will check it out.

Bill Walsh: All right. Going online and searching AARP Fighting for You. Thanks so much, Megan, for being with us today. Really appreciate it.

Megan O'Reilly: Thank you, Bill.

Bill Walsh: All right. Now it's time to address your questions on the prescription drug provisions of the Inflation Reduction Act with Leigh Purvis and David Mitchell. Please press *3 at any time on your telephone keypad, to be connected with an AARP staff member to share your question live. If you'd like to listen to this program in Spanish, press *0 on your telephone keypad now.

Bill Walsh: Okay, and right now I'd like to bring in my AARP colleague Jesse Salinas to help facilitate your calls today. Welcome, Jesse.

Jesse Salinas: So glad to be here, Bill.

Bill Walsh: All right, who is our first caller?

Jesse Salinas: Our first call today is from Paul in California.

Bill Walsh: Hey, Paul. Welcome to our program. Go ahead with your question.

Paul: Good morning. Thank you for taking our questions. So about two weeks ago, after the law was signed, I was watching one of the cable news channels and one of the talking heads, Chris Wallace, said that in fact only 10 drugs will be subject to negotiation, and he suggests the information being provided suggested that a much larger number of drugs would be under consideration. Is it true that only 10 drugs are the subject to negotiation by Medicare?

Bill Walsh: Thanks for that question. Paul, let's ask our experts. Leigh, you addressed this a little bit before. Can you expand on that and answer Paul's question?

Leigh Purvis: Absolutely. And thank you for the question. That's a good one. So, negotiation is actually going to be phased in over time. That first year, when the prices become available in 2026, they will be looking at 10 drugs. However, in 2027, there'll be 15 drugs. In 2028, there'll be another 15 drugs. And in 2029, there will be 20 drugs and beyond. So, what that means is that as many as 60 drugs could be negotiated by 2029, and that number will be cumulative. So even though there may be quote only 10 drugs in that first year, which remembering this is lifting at a big program off the ground, there will be additional drugs added over time. So, ultimately, there could be many more drugs added over the years to come.

Bill Walsh: Great. Thanks so much, Leigh, for that. Jesse, who is our next caller?

Jesse Salinas: Let's go with James in Pennsylvania.

Bill Walsh: Hey, James. Welcome to our program. Go ahead with your question.

Bill Walsh: Hi, James. Go ahead with your question.

James: Hello, it's James.

Bill Walsh: Hey, James, how are you?

James: Good.

Bill Walsh: Go ahead. Go ahead with your question for our panel.

James: Let me ask you a question. What happens to the don—, what happened to the “donut hole” that we talked about with Medicare Part D?

Bill Walsh: Yeah, that's a fair question. I'm sure our listeners are very familiar with the “donut hole” in Medicare. David Mitchell, can you talk about that a little bit?

David Mitchell: I'm going to try, Leigh knows this better than I do, but there is no longer a “donut hole” is the way I would answer that question. The structure of out of pockets, I believe, and Leigh you're going to correct me if I'm wrong, there'll still be a deductible that we all pay, and then we'll pay either 20 or 25 percent of the list price of the drugs we need up to, when it's fully effective, up to no more than $2,000. There's no more “donut hole.” And there will be no more catastrophic payments. The reason my drugs are so incredibly expensive for me out of pocket is because under the current law, when you hit the so-called catastrophic level, you pay 5 percent of list until Dec. 31st. Well, because my drug costs $21,000 every 28 days, that 5 percent adds up. We're going to make that 5 percent catastrophic payment go away and cap it hard at $2,000 a year and there's no more “donut hole.” Did I get it right, Leigh?

Leigh Purvis: As usual, David, you are absolutely right. Yes, the coverage gap will finally be banished. It will be eliminated, which I know is welcome news to a lot of people. The benefit structure itself is changing in 2025 as part of that new hard out-of-pocket cap. And part of that is getting rid of the coverage gap, which technically still existed but had been kind of covered over with a series of discounts, and now that part of the benefit will be gone. So people no longer have to worry about the coverage gap.

Bill Walsh: Well, that's fantastic. And just to be clear, Leigh, that $2,000 out-of-pocket limit takes effect, is it in 2025?

Leigh Purvis: That's correct.

Bill Walsh: Great. Okay, thanks both of you for that information. Oh, go ahead, David.

David Mitchell: I think it's important to add that in 2024, it will begin to step down and the maximum out of pocket that a patient like me can pay, and it'll step down to about, I think, 3 or $4,000, and then in 2025 it will go all the way down to $2,000 with full implementation of the law. So we'll start seeing the out-of-pocket maximums decline in, beginning in 2024.

Bill Walsh: That's going to be such a huge peace of mind for people to know that they, you know, they won't go bankrupt because of the cost of their drugs. Thanks so, thanks so much to both of you. Jesse, who do we have next on the line?

Jesse Salinas: Yeah, our next question is from YouTube. It's from Becky and she says, "I've read where your deductible will go towards the $2,000 out-of-pocket cost. What will this do to the options in Medicare Part D and/or premium cost?"

Bill Walsh: Hmm, Leigh, can you take that one?

Leigh Purvis: Yeah, that's another good question. Yes, your, any out-of-pocket spending that you incur will count towards that $2,000 out-of-pocket cap. The important thing to keep in mind as all of these changes are taking place is there's actually another provision within the Inflation Reduction Act that we haven't discussed that limits how much premiums can increase every year. And that's going to start in 2024 and go through 2029 and could go even further depending on how all of this is handled. So not only are you going to see reductions in your out-of-pocket spending, you are also going to be protected from any premium increases or big premium increases, I should say, that may result from all the changes that are taking place in such a short period of time.

Bill Walsh: Okay, thanks so much, Leigh. And I know for our listeners, this is, there's a lot of detail here and can get confusing really fast. If you're interested in reading more and keeping up on the latest, you can go to aarp.org and see the stories that our staff is writing, explainers on the new law, what it means for you, etc. Let's go back to the lines. Jesse, who do we have, who do we have next?

Jesse Salinas: Yeah, I've got one more question from Facebook and it says, "How does Canada provide prescriptions drugs at such a low cost compared to the US?"

Bill Walsh: David, can you tackle that question?

David Mitchell: Well, Canada has been doing effectively what we are going to begin to do as a result of the drug pricing provisions in the Inflation Reduction Act. It has negotiated directly with the drug companies over pricing. The other reason, frankly, is because Canada has a government-administered, maybe is the way to put it, health care program it negotiates for all the people in the country prices of drugs. And so it has been doing in terms of negotiating and saying, we're not going to be price takers, we're not going to let you tell us the price, drug companies, and then we'll pay it, whatever it is. Canada has been negotiating all along. We are going to begin to negotiate now in America, and as Leigh pointed out at the outset, this is long overdue. This is a fight that's been going on for 20 years to try and be able to use the purchasing power of Medicare to get a better deal for all of us.

Bill Walsh: Okay, very good. Jesse, who do we have up next?

Jesse Salinas: Yes, Bill. Our next question is going to be from Mary in Texas.

Bill Walsh: Hey, Mary, welcome to our program. Go ahead with your question.

Mary: I was wondering when the price of Eliquis was going to go down.

Bill Walsh: Okay, let's ask Leigh Purvis about that. Leigh, do we have any insight into that yet, or is that, will those sorts of very specific details be sorted out later? What can you tell Mary?

Leigh Purvis: Sure. So, another big question; everyone of course is very interested in hearing about their drugs that they're taking. We will know by the fall of next year which 10 drugs Medicare is planning to negotiate for the negotiated prices to become available in 2026. Eliquis is certainly on the short list considering how much Medicare spends on it, but the question is going to be whether it's going to qualify based on all of the criteria that has to be met before it becomes negotiated. So I would definitely say we’re keeping an eye on that one as a, probably a contender, but we can’t say for sure whether it’s going to be one of the negotiated drugs that would become available in 2026.

Bill Walsh: Okay. Thanks very much. Jesse, who do we have up next?

Jesse Salinas: Yeah, I’ve got Amy in Pennsylvania.

Bill Walsh: Hey, Amy. Welcome to our program. Go ahead with your question.

Amy: Yeah, hi. I have relatives that are on like regular Medicare with Part D, regular Medicare without Part D, and the Medicare Advantage. Obviously, the people that don’t have the Part D are not going to benefit from this assignment, I guess, but will the Medicare Advantage and the regular Medicare participants benefit in the same way? And also, when will Shingrix be free? I know people who are not taking it because of the expense.

Bill Walsh: Okay. Leigh, can you answer those questions?

Leigh Purvis: Sure. I’ll jump with Shingrix because that one’s super easy. That will be starting next year. So in 2023, your shingle shots will be no cost. So definitely go out there and grab them. The other question about where these provisions apply, it’s actually much broader than maybe it seems. For example, for negotiation, the prices of drugs under Medicare Part D as in Dog, which is what we’ve been talking about, but then also Medicare Part B as in Boy, will be included as well. So all of the drugs that Medicare covers will be included in negotiations and potentially negotiated. When we’re talking about the provisions that are specific to Medicare Part D, those are available for both people in standalone Medicare Part D plans, so people with traditional Medicare and a Part D plan, and to people who are in Medicare Advantage with Part D; so people who are in Medicare Advantage and also get their prescription drug coverage from that plan. Something else to mention also is, for example, those inflation penalties, when drug companies have to pay a penalty when their price increases faster than inflation, those also apply to all of the drugs that are covered under Medicare. So the reality is Medicare is really kind of taking and playing a role in a lot of prescription drugs. So regardless of how you are covered under Medicare, you will see some benefits.

Bill Walsh: Great. that's very helpful. Thanks, Leigh. Jesse, who do we have next on the line?

Jesse Salinas: Our next caller is Laurie from Michigan.

Bill Walsh: Hey, Laurie. Welcome to our program. Go ahead with your question.

Lori: Hi, thanks. I'd like to know what other vaccines might be covered besides Shingrix.

Bill Walsh: Leigh, since you were just talking about vaccines, do you want to continue talking about vaccines, which others would be covered?

Leigh Purvis: Shingles is the one that we've most, we've looked at most because we're so aware of the cost barriers that have been there in the past. When we talk about recommended vaccines, they are those vaccines that the Advisory Committee for Immunization Practices, ACIP, which is part of the Centers for Disease Control, has recommended for adults. So we have to look at those recommendations. I think others that have been mentioned are things like tetanus. I think it's important to kind of differentiate Medicare Part D plans have to cover all commercially available vaccines that are not covered under Medicare Part B as in Boy, which covers things like flu and pneumonia. So there's going to be some, potentially some, vaccines that aren't necessarily covered under this new provision with no cost, so it's important to take a look at what ACIP has recommended for adults. And those are the ones that are going to be covered under this provision.

Bill Walsh: Okay. Very good. Thanks, Leigh. Jesse, let's take another question from one of our listeners. Who's up next?

Jesse Salinas: Yeah, we're going to take this question from Facebook. We're getting a lot of questions similar to this, Bill. "Why have there not been any discussion of coupon discounts, which apparently the drug companies are funding, and start with some honest prescription pricing instead?"

Bill Walsh: Hmm, David, can you address that question?

David Mitchell: Wow. That is just a great question. People don't generally understand that drug companies don't give out discount coupons to help patients. They give out discount coupons to sell more drugs at ever-higher prices. They actually claim that these are charities, you know, charity contributions to help patients who can't afford their drugs. It's not true. They turn a profit on those coupons. Why? Because if they can give you a coupon to cover the 10 percent of costs that you would have to pay out of pocket, and they collect 90 percent of the price from Medicare, and they just keep raising the price, they make a lot of money by using discount coupons to make the out of pocket disappear and hurt less. It's why coupons, discount coupons, copay coupons are not allowed under Medicare. They're viewed as an illegal kickback, an inducement to buy a product which is not allowed under Medicare. So what drug companies do instead is they make donations to charities, so-called charities, and they earmark the donation for a specific disease. But the drug company knows how much market share they have for that disease with their own drug. So if it's disease X, and they know they have 90 percent of the market for the drug that is used to treat that disease, that 90 percent of what they give is going to come right back to them. So all of those things — copay coupons, so-called charities to cover out of pocket — they're all scams to spend more money, or to charge more money for drugs. What we need to do is what the questioner said, which is we need to lower the prices to make them fair so the drugs are affordable and accessible, not rely on gimmicks like copay coupons. And it's one of the issues we've got to continue to work on to address.

Bill Walsh: Now, David, let me follow up. Given the passage of this new law, do you expect consumers are going to continue to see discount offers from drug companies?

David Mitchell: Yeah, because we didn't make any changes to the law in this regard. And we're going to have to keep working to get to a point where we're actually offering drugs that are affordable and accessible for people and not relying on gimmicks and, really, scams. They're scams. You know these drug companies use coupons to sell more drugs the way, you know, the maker of Clorox tries to sell more Clorox. It's not about charity. It's not about helping people. It's about making more profit at our expense. So we need to lower prices and stop using discount coupons.

Bill Walsh: Okay, very good. Thanks to both our panelists, and thanks to our callers. We're going to take more caller questions shortly. Now it's time to address more of your questions with Leigh Purvis and David Mitchell. If you'd like to ask a question, go ahead and press *3 at any time on your telephone keypad to be connected with an AARP staff member to get in a queue, to ask that question live. Leigh, let me ask you this, this came up in one of the calls. When can individuals expect to see lower prices? That's what is on most people's minds. Can you walk us through the timetable for the rollout?

Leigh Purvis: A completely understandable question. I mentioned previously that Medicare is going to start negotiating in the next few years. So, as I mentioned, Medicare is going to choose those first 10 drugs to be negotiated by this time next year, and those first negotiated prices are going to become available in 2026. And then additional negotiated prices will become available every year from that point forward. So more specifically, and again, I mentioned this earlier, Medicare will negotiate prices for another 15 drugs in 2027 and 2028, and another 20 drugs in 2029 and beyond. So again, that could mean as many as 60 drugs could have a negotiated price by 2029. But the other thing we can't overlook is the provision that allows for penalties for drug companies that increase their prices faster than inflation. Drug companies are going to start facing those penalties at the end of this year. And while those penalties won't necessarily lead to lower drug prices, they are going to discourage drug companies from taking those incredibly high price increases that we hear about year after year. And that's really going to help with affordability as well. So there are a number of provisions that are going to address price that will be rolling out over the next few years, and hopefully people will see some changes soon.

Bill Walsh: Now, Leigh, you just talked about if a drug price exceeds inflation, what happens then? How high are the penalties that we're talking about and is, you know, will Medicare have the authority to force down the price below inflation?

Leigh Purvis: Yes, so drugmakers will have the ability to refuse to negotiate, but they are going to be subject to an escalating and very high excise tax that will equal a certain percentage of all of their sales during the time that they aren't complying. In effect, that excise tax could result in basically penalties that are higher than the price that they are charging. It can get extremely high. So effectively, drug companies would be paying to have their product on the market. So the expectation is that this tax is going to provide an extremely strong incentive for drug companies to participate throughout the negotiation process.

Bill Walsh: Okay, to both participate and to keep their drug prices below the rate of inflation.

Leigh Purvis: Absolutely, it will be very strongly encouraged.

Bill Walsh: Okay, very good. And lastly, Leigh, let me ask you about all of these changes we're talking about. Will they lower the drug costs for individuals or are we just talking about savings for the Medicare program?

Leigh Purvis: So that's what makes this such an incredible win, at least from my perspective, because the answer is both. The things that we've already talked about, so things like Medicare negotiation, the new out-of-pocket limit for people in prescription drug plans, penalties for drug companies to increase their prices faster than inflation, the copay caps for insulin, no-cost vaccines, cost sharing that can now be spread throughout the year. Those will help reduce prescription drug related costs for tens of millions of Medicare beneficiaries. Also, those Medicare beneficiaries who have not yet met their deductible or who are paying a percentage of their drug costs, which is known as coinsurance, will see a direct benefit of drug prices drop. And then we kind of alluded to some of the changes in the Medicare Part D benefit. Those are less visible, but Medicare will be paying less for people who hit catastrophic coverage. And that has been a huge share of Medicare spending lately. So that's going to help reduce Medicare spending on top of the reduced spending related to those lower prescription drug prices. So between that and the negotiation and the penalties for price increases and all of the other provisions in the law, I think Megan mentioned that the nonpartisan Congressional Budget Office has estimated that Medicare is going to save hundreds of billions of dollars over the next 10 years, which is obviously a huge win for both beneficiaries and the taxpayers who are helping to fund the program.

Bill Walsh: Very good. Thanks so much, Leigh. David, let me turn back to you. How can this legislation help people who are not on Medicare, who rely on expensive drugs, or will it?

David Mitchell: Well first, the measure of price increases that will be used to determine if a company is raising prices faster than inflation will be a measure looking at the prices in both public programs and in the private sector. So drug companies actually under this legislation, under this law, have an incentive to hold the line on private sector price increases in order to avoid paying penalties to Medicare for increasing prices faster than the rate of inflation. Second, you know the private sector has a lot of power to negotiate and employers who provide coverage to about half of all Americans and insurers who administer those plans will know the inflation capped price, and the negotiated prices will be public on the drugs that are ultimately negotiated. And those private sector actors can use that information as leverage in their bargaining to say, hey, the price in Medicare is this much. I want that price matched. But we do have to do more to curb abusive pricing in the private sector, especially for drugs like insulin. There's more to do there.

Bill Walsh: Yeah, yep. And, David, you touched on this a little bit a little bit earlier, this is a law, but it doesn't mean the drug companies will stop fighting it. What do you expect the drug companies to do next? Will they comply or have you seen signs they will try to undo this law?

David Mitchell: Well, I'm, I'm old, and so I remember listening to Neil Young, I'm an AARP member, and he had an album called Rust Never Sleeps. And I kind of think of big pharma as rust. The drug companies have already said they will do everything in their power to try and block effective implementation of the law and generally gum up the works. They are threatening legal challenges and other procedural moves; that's why this fight is not over. And all of us are very lucky to have AARP in the vanguard having done all this hard work to help us pass this law, but now working hard to make sure that we implement it effectively so the law will, in fact, take effect as intended and benefit millions of Americans.

Bill Walsh: Okay, now, David, one of the things that the drug companies have said consistently is that, you know, Medicare negotiating prices will stifle research in innovation. Is that true? Will we see fewer new drugs?

David Mitchell: Well, first of all, stifle research and innovation. I told you that I have an incurable blood cancer; it's incurable because no drug works forever, and they're going to have to invent some new drugs for me, or I'm going to die sooner than I hope to. So nobody cares more about innovation in new drug development than patients like me. And we are not putting our lives at risk by getting prices that are affordable. First of all, people are dying now because they can't afford the drugs they need now. We've had people die from, you know, trying to ration their own insulin. We have patients in our community, Patients for Affordable Drugs, who forgo buying their drugs, taking the recommended dose, don't take the best drug that works most effectively for them because of the price. Right now, by lowering prices, we can improve the health of Americans with the drugs that are available, but not affordable. Second, the Congressional Budget Office, which is nonpartisan, doesn't have an ax to grind, looked at the impact of this new law and concluded that out of 1,300 new drugs anticipated in the next 30 years, this law might reduce that number by 15. It's a drop in the bucket, especially because most new drugs are not actually therapeutic advancements, there will be two drugs, they're copycat drugs, so we're talking about a negligible to nonexistent impact on innovation in new drug development. And then finally the inflation caps are going to help with this. Right now, drug companies, in order to meet profit targets and trigger executive bonuses, they raise prices on old drugs and they don’t invest to develop new, innovative drugs that could command a high price. We’re not going to let them do that anymore. And so if they want to make more money, they’re going to have to invent new, innovative drugs that will command, and should command, a high price. So this legislation is actually going to spur innovation and new drug development, not the other way around.

Bill Walsh: All right. Thanks so much for that, David. Let’s go back to our listeners. It’s time now to address more of your questions with Leigh Purvis and David Mitchell. And as a reminder, press *3 at any time on your telephone keypad to be connected with an AARP staff member, or drop your question in the comments section on Facebook or YouTube. Jesse, who do we have next on the line?

Jesse Salinas: Yeah, we’re going to bring in Diane from Georgia.

Bill Walsh: Hey, Diane. How are you? Welcome to our program.

Diane: Hey, good. How are you guys?

Bill Walsh: Go ahead with your question. Very good. Go ahead.

Diane: My question is this, my question is this: I have a friend who is on a very expensive insulin and is not currently, Medicare doesn’t cover it really right now. Is that going to fall under this new low cost, low copay on insulin. When that, and is that, does that, that starts next year? Is that correct?

Bill Walsh: Yeah, Diane, can you give me a little more detail on the particular kind of insulin you’re talking about?

Diane: I do not know the name.

Bill Walsh: Okay, that’s okay. Well, let’s ask Leigh Purvis. Yeah, go ahead. Let me ask Leigh Purvis about coverage for insulin, and when that’s going to kick in. Leigh.

Leigh Purvis: Sure, so as you heard, those insulin copay caps are going to kick in starting next year, but they will apply to the insulin that the particular plan covers, which really drives home the importance of during open enrollment, which is about a month away, making sure that you look at your Medicare Part D plan options and make sure that your specific insulin is covered by the plan that you are going to enroll in. It’s incredibly important because plans cover insulins, but they don’t necessarily cover all insulins. So you want to make sure that whatever plan you enroll in covers that insulin, and then you will get that $35 maximum copay.

Bill Walsh: Okay, very good. Thanks so much, Leigh. Jesse, who do we have up next?

Jesse Salinas: This is Glendia in Texas.

Bill Walsh: Hey, how are you? Welcome.

Glendia: Good morning.

Bill Walsh: Hey, welcome to the program. Go ahead with your question,

Glendia: Thank you. My question is everything is very interesting and everything, but is there a place I can go and review everything? I’m a diabetic person and most of my medication is very expensive, but I can’t keep in everything that’s been told today. Is there a place I can go to and read up on it?

Bill Walsh: Yes, there sure is, Glendia. First of all, the program is being recorded and as of 24 hours from now, tomorrow, you'll be able to hear the whole thing again. You can also go to aarp.org and see the latest coverage of what's in the law and what it means for consumers. That coverage, there are dozens of articles there that touch on a lot of the information our two experts have provided today. And I believe there will also be a transcript of the program. A good site for you to go to is aarp.org/rx. Also, if you're an AARP member, keep an eye on the September AARP Bulletin, which is probably arriving in your mailboxes any day now. It has some extensive coverage of the new law and what it means for consumers. So I hope that helps. I don't know if Leigh or David want to provide any other tips.

Bill Walsh: Okay, well, Jesse, let's go ahead with our next call.

Jesse Salinas: Our next caller is Roger in Louisiana.

Bill Walsh: Hey, Roger. Welcome to our program. Go ahead with your question.

Roger: Yes, can you hear me?

Bill Walsh: Yep, sure. Can go ahead with your question.

Roger: Yeah, I was just, my question is, I know some of the medications are going to be negotiated next year, but I'm also baffled by the fact as to why it's going to be four years before any of the medications that they're going to review is going to be available to the public. That seems like a long time, four years, especially for those of us who may be in our 70s and 80s. And the other thing, I just...

Jesse Salinas: Bill, we lost him, my apologies.

Bill Walsh: Oh, I'm sorry. Sorry about that, Roger. But let's ask, let's pose your question. Roger wants to know; I mean he's asking a good question. Why is it taking four years for some of these provisions to kick in? Leigh, can you address that?

Leigh Purvis: Yeah. And I get this question a lot, and I fully appreciate it as someone who has numerous family members who will definitely benefit from the provisions in this legislation. And I think the short answer is that the magnitude of the changes that are taking place here cannot be overstated. And it just takes some time to implement. For example, if you look at Medicare Part D plans, they are pretty much set for next year already. Open enrollment starts in about a month. So there are limitations on how many changes can take place without really disrupting the market. It's also really important to keep in mind, for example, when it comes to negotiation, this country has never negotiated at that scale. We're talking about 60-plus million people and they're going to be starting kind of from scratch in some ways. We've heard from administrators that it's going to, they need to fill like a hundred positions. It's just going to take some time to get this process up and running and you also need to build in some time to negotiate with those drug companies. So there are some provisions that are happening sooner, like the no-cost vaccines and the penalties for those increased prices and the copay caps, but I appreciate the frustration in this, and it's incredibly important, and that's why we've been so engaged on this issue. And it really just kind of reflects the fact that this has been a fundamental change and we're making it clear that we're no longer going to accept pricing on the basis of what the market will bear. And that's a big change and that takes some time. So while there are some provisions that will be happening sooner, the reality is it's going to take a few years to get these others off the ground. But the one thing I also like to remind people is that Medicare Part D, which we've mentioned a lot, the law that created Medicare Part D was enacted in November 2003, but it didn't become effective until January 2006. So historically speaking, the changes of this magnitude takes some time, but it often gets overlooked once those benefits really start kicking in. So patience, and important, big changes are coming.

Bill Walsh: All right. Thanks very much for that, Leigh. Jesse, let's take another caller.

Jesse Salinas: Our next caller is Carrie in Massachusetts.

Bill Walsh: Hey, Carrie. Welcome to the program. Hey there, welcome to the program. Go ahead with your question.

Carrie: I have a question regarding prescription hearing aids. Is Medicare going to start under this new Affordable Care Act, start paying part of the prescription for them and if not, why?

Bill Walsh: Okay, good question. Leigh, can you address that? I know our colleague, Megan O’Reilly, said that AARP is still fighting for lower-cost hearing aids.

Leigh Purvis: Yes, that was part of the discussion in the early days of this legislation. But unfortunately it did not make it into the final package. But AARP is very engaged on the fact that those over-the-counter hearing aids are going to become available and next month, or excuse me, in two months. And that is a way that there will be increased competition and they will start seeing some lower-cost hearing aids coming on the market. So that's going to be these people that have that low or moderate hearing loss, and that access will be greatly improved by having those over-the-counter hearing aids available to everyone.

Bill Walsh: Let me follow up on that, Leigh. What about, what can you say about the quality of those over-the-counter hearing aids? Can consumers expect that they'll be as high quality as the ones they've been paying thousands of dollars for over the years?

Leigh Purvis: It's hard to say, because the market's just kind of getting started. We certainly anticipate that people will be able to access hearing aids that help them. You can always go to your health care provider if you feel like you have concerns about what you've been able to obtain in that way. But we fully expect that for people who have that low to moderate hearing loss, these products will definitely provide a benefit.

Bill Walsh: Very good. Thank you for that, Leigh. Jesse, let's take another listener question.

Jesse Salinas: Our next caller is from Chuck in Virginia?

Bill Walsh: Hey, Chuck, welcome to the program. Go ahead with your question.

Chuck: Yes, my understanding and observation is that this only applies to those people that have the Part D coverage in some form. I have Medicare, I don't think doesn't pay anything for my drugs. I think Tricare pays my, that's my, you know, secondary, if you will. I don't know if that counts as a Part D, so I don't know that this is really addressing anything except those that are fortunate enough to have Part D coverage.

Bill Walsh: Well, let's have Leigh Purvis address that. Leigh, you talked about the extent of the coverage today and who in Medicare would be eligible. Could you, could you talk about that again?

Leigh Purvis: Sure. So I think it's safe to say that a lot of the provisions that are included in this law are specific to Medicare. So if you're a Medicare Part D plan, someone who's in a Medicare Part D plan, or someone who's in traditional Medicare and you have a prescription drug that's covered under Medicare Part B, you will benefit from that. But I think David's point earlier was very well taken, which is that these provisions will have larger implications than I think they seem when you first look at them kind of at their surface. Going back to those inflation-based rebates, the price metric that is used to evaluate whether a penalty needs to be paid is based on a price that's broadly applicable. To the extent that those negotiated prices are publicly available, we could see other insurers saying, hey, we want those prices too. And we're also expecting that a lot of the ideas that are very popular in this law, so things like the insulin copay caps or creating those hard out-of-pocket caps, are probably going to trickle down to other parts of the health care system. So even though these provisions may be specific to Medicare, the reality is they're going to have much more wide-reaching implications and hopefully will provide benefits for a lot more people.

Bill Walsh: And, Leigh, let me just follow up. Chuck had mentioned Tricare. Would this affect people on, who rely on Tricare for their health insurance?

Leigh Purvis: Again, to the extent that Tricare decides to kind of build on the provisions or replicate the provisions that are in the law, you could see some benefits. Again, these are very popular ideas and I think that a lot of insurers are going to be paying attention to what happens under Medicare and potentially try to find ways to do that themselves.

Bill Walsh: Okay, well, thank you, Leigh. And thank you to David Mitchell as well. This has been a really informative discussion. I also want to thank you, our AARP members, volunteers and listeners for participating in the discussion today. AARP, a nonprofit, nonpartisan membership organization has been working to promote the health and well-being of older Americans for more than 60 years. All the resources referenced today, including a recording of the Q&A event, can be found at AARP.org/coronavirus on Sept. 8th, tomorrow. Go there if your question was not addressed, and you'll find the latest updates as well as information created specifically for older adults and family caregivers. Also, please join us on Sept. 15th for a live coronavirus Q&A event, and also on Sept. 22nd for a special live Q&A event with personal finance expert Suze Orman, who will join AARP's CEO, Joanne Jenkins, to address inflation and how to manage your money and cut costs. Thank you for joining us today and have a good day. This concludes our call.

[00:00:00] Bill Walsh: Hello. I am AARP Vice President Bill Walsh and I want to welcome you to this important discussion about AARP's fight to lower prescription drug prices. Before we begin, if you'd like to hear this telephone town hall in Spanish, press *0 on your telephone keypad now.

[00:00:18] AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. And for much of that time, AARP has been fighting hard on behalf of older adults to lower prescription drug costs. And we've won a significant victory. A law passed in August will help millions of older adults save money on their medications after years of paying the highest prices in the world. While this victory is sweet, the fight isn't over. AARP will continue to fight to ensure the law is implemented and continue to advocate for additional measures to make prescription drugs affordable.

[00:01:07] Today we'll hear from impressive panel experts about this historic win and what it means for you. We also get an update from Capitol Hill on this legislation and what AARP is doing to continue the fight to lower prescription drug prices. If you've participated in one of our Tele-Town Halls in the past, you know this is similar to a radio talk show, and you have the opportunity to ask your questions live. For those of you joining us on the phone, if you'd like to ask a question about the fight to lower prescription drug prices, press *3 on your telephone keypad. You'll be connected with an AARP staff member who will note your name and question and place you in a queue to ask that question live. If you're joining us on Facebook or YouTube, you can drop your question in the comments section.

[00:01:57] Hello, if you're just joining, I'm Bill Walsh with AARP and I want to welcome you to this important discussion about the fight to lower prescription drug prices. We're talking with leading experts and taking your questions live. To ask your question, please press *3 on your telephone keypad, and if you're joining on Facebook or YouTube, drop your question in the comments section.

[00:02:19] We have some outstanding guests joining us, including a public health policy specialist and an expert on prescription drug pricing and coverage. We'll also be joined by my AARP colleague Jesse Salinas, who will help facilitate your calls today. This event is being recorded and you can access the recording at aarp.org/coronavirus 24 hours after we wrap up. Again, to ask your question, please press *3 at any time on your telephone keypad to be connected with an AARP staff member, and if you're joining on Facebook or YouTube, drop your question into the comments section.

[00:03:00] Now I'd like to welcome our guests. Leigh Purvis is the director of Healthcare Cost and Access at AARP. Welcome to the program, Leigh.

[00:03:09] Leigh Purvis: Thank you so much for having me.

[00:03:11] Bill Walsh: All right, thanks so much for being with us. Leigh is joined by David Mitchell. David is the president and founder of the nonprofit group Patients for Affordable Drugs, which advocates for lower prescription drug prices. Welcome, David.

[00:03:25] David Mitchell: Bill, thank you very much. Glad to be here.

[00:03:27] Bill Walsh: All right. We're delighted to have both of you. And just a reminder to our listeners, to ask your question, press *3 on your telephone keypad or drop it in the comments section on Facebook or YouTube.

[00:03:41] All right. Let's get started. Leigh, efforts to allow Medicare to negotiate prices have been going on for decades. Why is this so important for AARP and for consumers?

[00:03:55] Leigh Purvis: Yeah, AARP has been advocating for Medicare negotiation for almost 20 years now, which is kind of amazing to say out loud. Our perspective has always been that it makes absolutely no sense for the Medicare program and its more than 60 million beneficiaries to be stuck paying prescription drug prices that are largely based on what the market will bear. Now in Medicare's prescription drug benefit, or Part D, was created nearly two decades ago. The bill explicitly said that Medicare could not negotiate with drug companies. Some Part D plans were able to negotiate on behalf of their enrollees, so there was some price negotiation taking place, but even the biggest prescription drug plans do not have the same clout as Medicare when it's negotiating on behalf of everyone in the program. And that is why AARP has been pushing so hard for Medicare negotiation. The program will have an incredible amount of power at the bargaining table, and that will lead to a much better deal for Medicare beneficiaries and the taxpayers who help fund the program.

[00:04:53] Bill Walsh: Thanks for that. Leigh, now can you provide some examples of drugs that could be included in the negotiations?

[00:05:00] Leigh Purvis: Sure, and just to be clear there are some limits on which drugs can be eligible for negotiation. For example, all of the drugs have to be single source, meaning there's no generic competition on the market. And the newest drugs on the market will not be eligible for negotiation. The drugs will also, the drugs that will be eligible for negotiation will only be entered into kind of the system if it's been a certain number of years since they were approved by the U.S. Food and Drug Administration. So some very high-spend drugs that currently meet those thresholds include drugs like Eliquis, which is a very common blood thinner; Genovia, which is used to treat diabetes; and XTANDI on drugs that are used to treat cancer. Some other drugs we've been eyeing that don't currently meet the threshold but could meet them by the time negotiation really kicks off include drugs like Imbruvica, which is for cancer; Jardiance, which is for diabetes; and Eylea, which is for age-related macular degeneration. So really looking at a very broad number and type of drugs that could be eligible for negotiation in the near future.

[00:06:05] Bill Walsh: Yeah. And those names, those are probably pretty familiar to people who watch all of the ads on TV. So I imagine they are drugs taken by millions of people across the country. Leigh, of course the prescription drug benefits are embedded in the law called the Inflation Reduction Act of 2022. Which provisions of that act are going to matter most to Medicare beneficiaries?

[00:06:34] Leigh Purvis: So first and foremost, I would probably have to say, as I just mentioned, Medicare negotiations. There's also a new $2,000 annual out-of-pocket limit for people in prescription drug plans. And there are also penalties for drug companies that increase their prices faster than inflation. And something else has caught a lot of attention is the new monthly copay caps for insulin of $35 that will help millions of Medicare beneficiaries. This is a really important mix of provisions that will address those high out-of-pocket costs and the higher prescription drug prices that are driving them. But I don't want to leave anything behind. This is like choosing your favorite child. So there are a lot of other provisions that I think will help as well. For example, starting next year recommended vaccines will be available at no cost in Medicare. This includes vaccines like shingles, which we know can cost upwards of $300 out of pocket. So that is a real meaningful change for people who perhaps have been hesitant to pay for that vaccine. We also know that a lot more people are going to be eligible for Medicare's extra-help program, which can significantly reduce your prescription drug related costs and premiums. And people in Medicare prescription drug plans will also be able to smooth their cost sharing over the entire year, rather than face really high costs over a short period of time. So another way of looking at it is there really is something in there for pretty much everyone.

[00:07:57] Bill Walsh: That's great. Thanks so much, Leigh. And we're going to touch, we're going to dig into some of those provisions later on in the program, but let me turn to our next guest, David Mitchell. Don't private insurers and the Veterans Administration negotiate prices with drugmakers now? How is that different or the same from what Medicare will be doing?

[00:08:19] David Mitchell: Well, Medicare is the largest purchaser of drugs in the U.S. And as Leigh pointed out, until now it's been prohibited expressly from using that purchasing power to get a better deal for Americans. And the approach that will be taken in the negotiations is somewhat different from what private insurers and the Veterans Administration does, they use a different structure for the negotiations. This new law will set up a process that seeks to lower the prices of old drugs that should have competition, but don't, and that are costing patients and taxpayers an inordinate amount of money. And so the structure for the negotiation, the targets for negotiation are somewhat different. But importantly, the drug companies wanted nothing to do with any of this. They got that prohibition on Medicare negotiating directly with drug companies back in 2003, and they have been lobbying, Leigh pointed out, AARP has been fighting this fight for almost 20 years. They've been spending — the drug companies — hundreds of millions of dollars on lobbying and campaign contributions to keep that prohibition so they could continue to dictate the prices of brand-name drugs to the American people. Well, this year the American people rose up and said enough. AARP took the lead in fighting to get this legislation passed and now we will, in fact, be able to bring that negotiating power of Medicare to bear for millions of Americans.

[00:10:23] Bill Walsh: All right. That's great to hear. David Leigh was talking about some of the particular benefits. I want to ask you about them as well. What about people who have cancer or other life-threatening conditions? How does this legislation impact them?

[00:10:39] David Mitchell: Yep, well, I'm one of those people, Bill. I have an incurable blood cancer. It's called multiple myeloma, and right now my doctors have me on a four-drug combination that carries a list price of more than $900,000 a year. Now I'm very grateful for these drugs, they're keeping me alive, literally, but they're wildly overpriced, and they're overpriced because the drug companies use all sorts of tactics to block competition, to extend their monopolies, the exact abusive behaviors that this legislation — by attacking these drugs that have been on the market for a long time, that should have competition, but don't — aims to address. Just one of my drugs under Medicare Part D, an oral drug, a chemo drug, costs me more than $16,000 a year out of pocket. Now Leigh pointed out that for the first time ever there is going to be an out-of-pocket cap for Medicare beneficiaries at $2,000 a year. This is going to be transformative for me and millions of other cancer patients over time because instead of being at the mercy of no out-of-pocket cap that can lead to my, you know, as much as I'm paying more than $16,000 a year, all of a sudden that's going to come down when the law fully takes effect to $2,000. This is a big deal. And the inflation limits on price increases will affect all of us by holding the line and stopping price gouging by the drug companies.

[00:12:33] Bill Walsh: Yeah, well that's tremendous. That's a real-world impact that's going to not just benefit you, David, but millions of people on Medicare. Thanks for that. And as a reminder to our listeners, to ask your question of our expert panel, please go ahead and press *3 on your telephone, keypad, and we're going to get to those live questions shortly. But before we do, I want to bring in Megan O'Reilly. Megan is the vice president of Health and Family Advocacy at AARP, and she's going to update our listeners about how AARP is fighting for them on Capitol Hill. Welcome, Megan.

[00:13:09] Megan O'Reilly: Happy to be here, Bill.

[00:13:11] Bill Walsh: First of all, congratulations to AARP as well as the many AARP volunteers and members across the country who fought so hard over so many years to make lower drug prices a reality.

[00:13:25] Megan O'Reilly: Thank you. You know, we are thrilled with the passage of this historic legislation, which is really a victory for all older Americans. After decades of calling on Congress to make prescription drugs more affordable, AARP has won the fight for Medicare to negotiate lower drug prices and help seniors save money on their medications.

[00:13:44] Bill Walsh: All right. Now, going back to the beginning, why is AARP involved in the fight to lower prescription drug prices?

[00:13:53] Megan O'Reilly: One of the things we hear from most, from our members, is that frustration and desperation that comes from trying to afford the skyrocketing prices of prescription drugs. The most common reason that older people skip medications or ration their medications is because they can't afford it and letting Medicare to negotiate for lower drug prices is a common-sense solution. It will strengthen Medicare and, together with the new out-of-pocket cap in Part D, put money back in the pockets and at the same time for seniors that are struggling to afford the rising costs of medications and other basic needs.

[00:14:30] Bill Walsh: Okay. And as I mentioned before, we're specifically talking about the Inflation Reduction Act of 2022, which was passed by both the House and the Senate, and then signed into law on Aug. 16th. What are some of the important items included in this bill that AARP fought to make a reality?

[00:14:50] Megan O'Reilly: Both Leigh and David have hit on some of that but let me just go through this for you once again. The legislation is going to allow Medicare to negotiate for the first time some of those drugs with the highest cost prices that millions of Americans, millions of seniors are taking. The bill is also, beginning in 2025 as we've talked about, going to put a hard $2,000 limit on how much a senior in Part D will have to pay out of pocket for their medications. And it's going to penalize drugmakers that increase those prices faster than the rate of inflation starting this year. And finally, the new law caps the cost of Medicare-covered insulin at $35 a month and eliminates out-of-pocket costs for most vaccines, such as shingles, under Medicare. This bill will save seniors and Medicare hundreds of billions of dollars and give seniors peace of mind knowing that there is an annual limit on what they must pay out of pocket for medications.

[00:15:49] Bill Walsh: Okay, Megan, I mean, those are, those are a lot of provisions. Can you talk about when consumers will see some of these changes taking place?

[00:15:58] Megan O'Reilly: Sure. There's some that will be immediate and there's some that will take a few years to implement. So later this year, drug companies that increase the prices of their products faster than the rate of inflation will have to start paying back rebates, penalties to the government. At start of next year, copays for insulin and Medicare will be capped at $35, and people on Medicare will no longer have to pay for any recommended vaccine, like I mentioned, shingles. Other improvements will save seniors and Medicare money like caps on out-of-pocket payments in Part D and requiring Medicare to negotiate. That will take effect in the years that follow.

[00:16:38] Bill Walsh: Okay, well, that's all great news. This is a historic win. What's next for AARP?

[00:16:43] Megan O'Reilly: This is a huge victory, but as you've said, the fight is not over. We know big drug companies will spend millions trying to overturn or undermine the new law so that they can keep charging Americans the highest prices in the world. AARP will keep fighting big drug companies' out-of-control prices, and we will not back down. Our top priority is to see these changes implemented and to do more to ensure that seniors can afford their medications.

[00:17:12] Bill Walsh: All right. Well, that's great to hear. Megan, maybe you can talk about some of the other health priorities AARP is fighting for.

[00:17:21] Megan O'Reilly: AARP is fighting for many ways to protect the health of older Americans. Right now, we're fighting for help for family caregivers and working to provide seniors with greater access to home care and more nursing home protections. We're also fighting for dental coverage in Medicare. We've successfully weighed in with the Centers for Medicare and Medicaid Services to expand when Medicare will cover dental care when it's tied to another health condition covered by the Medicare program. And we're going to continue to advocate for broader dental coverage, as well as hearing and vision care. We've advocated for the new over-the-counter hearing aid rule that was released last month. Lower-cost hearing aids will now be available for those of you with low to moderate hearing loss, starting in October. This comes after years of AARP's bipartisan work with Congress and the administration to expand access to lower-cost hearing aids. We're also continuing to fight to allow greater use of telehealth, working to solve senior hunger and food insecurity, we're advocating on mental health coverage, and fighting to expand access to affordable health care. AARP is fighting hard to improve your health care and quality of life.

[00:18:32] Bill Walsh: All right, Megan. Thanks. That's a lot of important work and of course AARP couldn't do it without its millions of members and volunteers working with AARP and on its behalf, so congratulations to everybody involved in what I know has been a decades' long fight to make this happen. Megan, finally, if our listeners want to stay on top of AARP's advocacy news, how can they find out the latest updates?

[00:19:00] Megan O'Reilly: Sure, we would encourage everyone to go online and search AARP Fighting for You. That will lead you to a daily roundup of all the latest advocacy news and updates on our work with Congress and across the country. It's really a great way to stay informed, and we hope that you will check it out.

[00:19:18] Bill Walsh: All right. Going online and searching AARP Fighting for You. Thanks so much, Megan, for being with us today. Really appreciate it.

[00:19:26] Megan O'Reilly: Thank you, Bill.

[00:19:27] Bill Walsh: All right. Now it's time to address your questions on the prescription drug provisions of the Inflation Reduction Act with Leigh Purvis and David Mitchell. Please press *3 at any time on your telephone keypad, to be connected with an AARP staff member to share your question live. If you'd like to listen to this program in Spanish, press *0 on your telephone keypad now.

[00:19:58] Okay, and right now I'd like to bring in my AARP colleague Jesse Salinas to help facilitate your calls today. Welcome, Jesse.

[00:20:06] Jesse Salinas: So glad to be here, Bill.

[00:20:08] Bill Walsh: All right, who is our first caller?

[00:20:11] Jesse Salinas: Our first call today is from Paul in California.

[00:20:15] Bill Walsh: Hey, Paul. Welcome to our program. Go ahead with your question.

[00:20:19] Paul: Good morning. Thank you for taking our questions. So about two weeks ago, after the law was signed, I was watching one of the cable news channels and one of the talking heads, Chris Wallace, said that in fact only 10 drugs will be subject to negotiation, and he suggests the information being provided suggested that a much larger number of drugs would be under consideration. Is it true that only 10 drugs are the subject to negotiation by Medicare?

[00:20:48] Bill Walsh: Thanks for that question. Paul, let's ask our experts. Leigh, you addressed this a little bit before. Can you expand on that and answer Paul's question?

[00:20:56] Leigh Purvis: Absolutely. And thank you for the question. That's a good one. So, negotiation is actually going to be phased in over time. That first year, when the prices become available in 2026, they will be looking at 10 drugs. However, in 2027, there'll be 15 drugs. In 2028, there'll be another 15 drugs. And in 2029, there will be 20 drugs and beyond. So, what that means is that as many as 60 drugs could be negotiated by 2029, and that number will be cumulative. So even though there may be quote only 10 drugs in that first year, which remembering this is lifting at a big program off the ground, there will be additional drugs added over time. So, ultimately, there could be many more drugs added over the years to come.

[00:21:38] Bill Walsh: Great. Thanks so much, Leigh, for that. Jesse, who is our next caller?

[00:21:43] Jesse Salinas: Let's go with James in Pennsylvania.

[00:21:47] Bill Walsh: Hey, James. Welcome to our program. Go ahead with your question.

[00:21:53] Hi, James. Go ahead with your question.

[00:21:56] James: Hello, it's James.

[00:21:58] Bill Walsh: Hey, James, how are you?

[00:22:00] James: Good.

[00:22:01] Bill Walsh: Go ahead. Go ahead with your question for our panel.

[00:22:05] James: Let me ask you a question. What happens to the don—, what happened to the “donut hole” that we talked about with Medicare Part D?

[00:22:14] Bill Walsh: Yeah, that's a fair question. I'm sure our listeners are very familiar with the “donut hole” in Medicare. David Mitchell, can you talk about that a little bit?

[00:22:23] David Mitchell: I'm going to try, Leigh knows this better than I do, but there is no longer a “donut hole” is the way I would answer that question. The structure of out of pockets, I believe, and Leigh you're going to correct me if I'm wrong, there'll still be a deductible that we all pay, and then we'll pay either 20 or 25 percent of the list price of the drugs we need up to, when it's fully effective, up to no more than $2,000. There's no more “donut hole.” And there will be no more catastrophic payments. The reason my drugs are so incredibly expensive for me out of pocket is because under the current law, when you hit the so-called catastrophic level, you pay 5 percent of list until Dec. 31st. Well, because my drug costs $21,000 every 28 days, that 5 percent adds up. We're going to make that 5 percent catastrophic payment go away and cap it hard at $2,000 a year and there's no more “donut hole.” Did I get it right, Leigh?

[00:23:44] Leigh Purvis: As usual, David, you are absolutely right. Yes, the coverage gap will finally be banished. It will be eliminated, which I know is welcome news to a lot of people. The benefit structure itself is changing in 2025 as part of that new hard out-of-pocket cap. And part of that is getting rid of the coverage gap, which technically still existed but had been kind of covered over with a series of discounts, and now that part of the benefit will be gone. So people no longer have to worry about the coverage gap.

[00:24:14] Bill Walsh: Well, that's fantastic. And just to be clear, Leigh, that $2,000 out-of-pocket limit takes effect, is it in 2025?

[00:24:23] Leigh Purvis: That's correct.

[00:24:24] Bill Walsh: Great. Okay, thanks both of you for that information. Oh, go ahead, David.

[00:24:29] David Mitchell: I think it's important to add that in 2024, it will begin to step down and the maximum out of pocket that a patient like me can pay, and it'll step down to about, I think, 3 or $4,000, and then in 2025 it will go all the way down to $2,000 with full implementation of the law. So we'll start seeing the out-of-pocket maximums decline in, beginning in 2024.

[00:24:59] Bill Walsh: That's going to be such a huge peace of mind for people to know that they, you know, they won't go bankrupt because of the cost of their drugs. Thanks so, thanks so much to both of you. Jesse, who do we have next on the line?

[00:25:14] Jesse Salinas: Yeah, our next question is from YouTube. It's from Becky and she says, "I've read where your deductible will go towards the $2,000 out-of-pocket cost. What will this do to the options in Medicare Part D and/or premium cost?"

[00:25:28] Bill Walsh: Hmm, Leigh, can you take that one?

[00:25:31] Leigh Purvis: Yeah, that's another good question. Yes, your, any out-of-pocket spending that you incur will count towards that $2,000 out-of-pocket cap. The important thing to keep in mind as all of these changes are taking place is there's actually another provision within the Inflation Reduction Act that we haven't discussed that limits how much premiums can increase every year. And that's going to start in 2024 and go through 2029 and could go even further depending on how all of this is handled. So not only are you going to see reductions in your out-of-pocket spending, you are also going to be protected from any premium increases or big premium increases, I should say, that may result from all the changes that are taking place in such a short period of time.

[00:26:13] Bill Walsh: Okay, thanks so much, Leigh. And I know for our listeners, this is, there's a lot of detail here and can get confusing really fast. If you're interested in reading more and keeping up on the latest, you can go to aarp.org and see the stories that our staff is writing, explainers on the new law, what it means for you, etc. Let's go back to the lines. Jesse, who do we have, who do we have next?

[00:26:42] Jesse Salinas: Yeah, I've got one more question from Facebook and it says, "How does Canada provide prescriptions drugs at such a low cost compared to the US?"

[00:26:51] Bill Walsh: David, can you tackle that question?

[00:26:55] David Mitchell: Well, Canada has been doing effectively what we are going to begin to do as a result of the drug pricing provisions in the Inflation Reduction Act. It has negotiated directly with the drug companies over pricing. The other reason, frankly, is because Canada has a government-administered, maybe is the way to put it, health care program it negotiates for all the people in the country prices of drugs. And so it has been doing in terms of negotiating and saying, we're not going to be price takers, we're not going to let you tell us the price, drug companies, and then we'll pay it, whatever it is. Canada has been negotiating all along. We are going to begin to negotiate now in America, and as Leigh pointed out at the outset, this is long overdue. This is a fight that's been going on for 20 years to try and be able to use the purchasing power of Medicare to get a better deal for all of us.

[00:28:06] Bill Walsh: Okay, very good. Jesse, who do we have up next?

[00:28:12] Jesse Salinas: Yes, Bill. Our next question is going to be from Mary in Texas.

[00:28:18] Bill Walsh: Hey, Mary, welcome to our program. Go ahead with your question.

[00:28:24] Mary: I was wondering when the price of Eliquis was going to go down.

[00:28:31] Bill Walsh: Okay, let's ask Leigh Purvis about that. Leigh, do we have any insight into that yet, or is that, will those sorts of very specific details be sorted out later? What can you tell Mary?

[00:28:44] Leigh Purvis: Sure. So, another big question; everyone of course is very interested in hearing about their drugs that they're taking. We will know by the fall of next year which 10 drugs Medicare is planning to negotiate for the negotiated prices to become available in 2026. Eliquis is certainly on the short list considering how much Medicare spends on it, but the question is going to be whether it's going to qualify based on all of the criteria that has to be met before it becomes negotiated. So I would definitely say we’re keeping an eye on that one as a, probably a contender, but we can’t say for sure whether it’s going to be one of the negotiated drugs that would become available in 2026.

[00:29:25] Bill Walsh: Okay. Thanks very much. Jesse, who do we have up next?

[00:29:30] Jesse Salinas: Yeah, I’ve got Amy in Pennsylvania.

[00:29:33] Bill Walsh: Hey, Amy. Welcome to our program. Go ahead with your question.

[00:29:38] Amy: Yeah, hi. I have relatives that are on like regular Medicare with Part D, regular Medicare without Part D, and the Medicare Advantage. Obviously, the people that don’t have the Part D are not going to benefit from this assignment, I guess, but will the Medicare Advantage and the regular Medicare participants benefit in the same way? And also, when will Shingrix be free? I know people who are not taking it because of the expense.

[00:30:07] Bill Walsh: Okay. Leigh, can you answer those questions?

[00:30:11] Leigh Purvis: Sure. I’ll jump with Shingrix because that one’s super easy. That will be starting next year. So in 2023, your shingle shots will be no cost. So definitely go out there and grab them. The other question about where these provisions apply, it’s actually much broader than maybe it seems. For example, for negotiation, the prices of drugs under Medicare Part D as in Dog, which is what we’ve been talking about, but then also Medicare Part B as in Boy, will be included as well. So all of the drugs that Medicare covers will be included in negotiations and potentially negotiated. When we’re talking about the provisions that are specific to Medicare Part D, those are available for both people in standalone Medicare Part D plans, so people with traditional Medicare and a Part D plan, and to people who are in Medicare Advantage with Part D; so people who are in Medicare Advantage and also get their prescription drug coverage from that plan. Something else to mention also is, for example, those inflation penalties, when drug companies have to pay a penalty when their price increases faster than inflation, those also apply to all of the drugs that are covered under Medicare. So the reality is Medicare is really kind of taking and playing a role in a lot of prescription drugs. So regardless of how you are covered under Medicare, you will see some benefits.

[00:31:34] Bill Walsh: Great. that's very helpful. Thanks, Leigh. Jesse, who do we have next on the line?

[00:31:39] Jesse Salinas: Our next caller is Laurie from Michigan.

[00:31:43] Bill Walsh: Hey, Laurie. Welcome to our program. Go ahead with your question.

[00:31:47] Lori: Hi, thanks. I'd like to know what other vaccines might be covered besides Shingrix.

[00:31:55] Bill Walsh: Leigh, since you were just talking about vaccines, do you want to continue talking about vaccines, which others would be covered?

[00:32:01] Leigh Purvis: Shingles is the one that we've most, we've looked at most because we're so aware of the cost barriers that have been there in the past. When we talk about recommended vaccines, they are those vaccines that the Advisory Committee for Immunization Practices, ACIP, which is part of the Centers for Disease Control, has recommended for adults. So we have to look at those recommendations. I think others that have been mentioned are things like tetanus. I think it's important to kind of differentiate Medicare Part D plans have to cover all commercially available vaccines that are not covered under Medicare Part B as in Boy, which covers things like flu and pneumonia. So there's going to be some, potentially some, vaccines that aren't necessarily covered under this new provision with no cost, so it's important to take a look at what ACIP has recommended for adults. And those are the ones that are going to be covered under this provision.

[00:32:55] Bill Walsh: Okay. Very good. Thanks, Leigh. Jesse, let's take another question from one of our listeners. Who's up next?

[00:33:01] Jesse Salinas: Yeah, we're going to take this question from Facebook. We're getting a lot of questions similar to this, Bill. "Why have there not been any discussion of coupon discounts, which apparently the drug companies are funding, and start with some honest prescription pricing instead?"

[00:33:14] Bill Walsh: Hmm, David, can you address that question?

[00:33:18] David Mitchell: Wow. That is just a great question. People don't generally understand that drug companies don't give out discount coupons to help patients. They give out discount coupons to sell more drugs at ever-higher prices. They actually claim that these are charities, you know, charity contributions to help patients who can't afford their drugs. It's not true. They turn a profit on those coupons. Why? Because if they can give you a coupon to cover the 10 percent of costs that you would have to pay out of pocket, and they collect 90 percent of the price from Medicare, and they just keep raising the price, they make a lot of money by using discount coupons to make the out of pocket disappear and hurt less. It's why coupons, discount coupons, copay coupons are not allowed under Medicare. They're viewed as an illegal kickback, an inducement to buy a product which is not allowed under Medicare. So what drug companies do instead is they make donations to charities, so-called charities, and they earmark the donation for a specific disease. But the drug company knows how much market share they have for that disease with their own drug. So if it's disease X, and they know they have 90 percent of the market for the drug that is used to treat that disease, that 90 percent of what they give is going to come right back to them. So all of those things — copay coupons, so-called charities to cover out of pocket — they're all scams to spend more money, or to charge more money for drugs. What we need to do is what the questioner said, which is we need to lower the prices to make them fair so the drugs are affordable and accessible, not rely on gimmicks like copay coupons. And it's one of the issues we've got to continue to work on to address.

[00:35:51] Bill Walsh: Now, David, let me follow up. Given the passage of this new law, do you expect consumers are going to continue to see discount offers from drug companies?

[00:36:01] David Mitchell: Yeah, because we didn't make any changes to the law in this regard. And we're going to have to keep working to get to a point where we're actually offering drugs that are affordable and accessible for people and not relying on gimmicks and, really, scams. They're scams. You know these drug companies use coupons to sell more drugs the way, you know, the maker of Clorox tries to sell more Clorox. It's not about charity. It's not about helping people. It's about making more profit at our expense. So we need to lower prices and stop using discount coupons.

[00:36:43] Bill Walsh: Okay, very good. Thanks to both our panelists, and thanks to our callers. We're going to take more caller questions shortly. Now it's time to address more of your questions with Leigh Purvis and David Mitchell. If you'd like to ask a question, go ahead and press *3 at any time on your telephone keypad to be connected with an AARP staff member to get in a queue, to ask that question live. Leigh, let me ask you this, this came up in one of the calls. When can individuals expect to see lower prices? That's what is on most people's minds. Can you walk us through the timetable for the rollout?

[00:37:20] Leigh Purvis: A completely understandable question. I mentioned previously that Medicare is going to start negotiating in the next few years. So, as I mentioned, Medicare is going to choose those first 10 drugs to be negotiated by this time next year, and those first negotiated prices are going to become available in 2026. And then additional negotiated prices will become available every year from that point forward. So more specifically, and again, I mentioned this earlier, Medicare will negotiate prices for another 15 drugs in 2027 and 2028, and another 20 drugs in 2029 and beyond. So again, that could mean as many as 60 drugs could have a negotiated price by 2029. But the other thing we can't overlook is the provision that allows for penalties for drug companies that increase their prices faster than inflation. Drug companies are going to start facing those penalties at the end of this year. And while those penalties won't necessarily lead to lower drug prices, they are going to discourage drug companies from taking those incredibly high price increases that we hear about year after year. And that's really going to help with affordability as well. So there are a number of provisions that are going to address price that will be rolling out over the next few years, and hopefully people will see some changes soon.

[00:38:34] Bill Walsh: Now, Leigh, you just talked about if a drug price exceeds inflation, what happens then? How high are the penalties that we're talking about and is, you know, will Medicare have the authority to force down the price below inflation?

[00:38:52] Leigh Purvis: Yes, so drugmakers will have the ability to refuse to negotiate, but they are going to be subject to an escalating and very high excise tax that will equal a certain percentage of all of their sales during the time that they aren't complying. In effect, that excise tax could result in basically penalties that are higher than the price that they are charging. It can get extremely high. So effectively, drug companies would be paying to have their product on the market. So the expectation is that this tax is going to provide an extremely strong incentive for drug companies to participate throughout the negotiation process.

[00:39:35] Bill Walsh: Okay, to both participate and to keep their drug prices below the rate of inflation.

[00:39:42] Leigh Purvis: Absolutely, it will be very strongly encouraged.

[00:39:46] Bill Walsh: Okay, very good. And lastly, Leigh, let me ask you about all of these changes we're talking about. Will they lower the drug costs for individuals or are we just talking about savings for the Medicare program?

[00:40:03] Leigh Purvis: So that's what makes this such an incredible win, at least from my perspective, because the answer is both. The things that we've already talked about, so things like Medicare negotiation, the new out-of-pocket limit for people in prescription drug plans, penalties for drug companies to increase their prices faster than inflation, the copay caps for insulin, no-cost vaccines, cost sharing that can now be spread throughout the year. Those will help reduce prescription drug related costs for tens of millions of Medicare beneficiaries. Also, those Medicare beneficiaries who have not yet met their deductible or who are paying a percentage of their drug costs, which is known as coinsurance, will see a direct benefit of drug prices drop. And then we kind of alluded to some of the changes in the Medicare Part D benefit. Those are less visible, but Medicare will be paying less for people who hit catastrophic coverage. And that has been a huge share of Medicare spending lately. So that's going to help reduce Medicare spending on top of the reduced spending related to those lower prescription drug prices. So between that and the negotiation and the penalties for price increases and all of the other provisions in the law, I think Megan mentioned that the nonpartisan Congressional Budget Office has estimated that Medicare is going to save hundreds of billions of dollars over the next 10 years, which is obviously a huge win for both beneficiaries and the taxpayers who are helping to fund the program.

[00:41:32] Bill Walsh: Very good. Thanks so much, Leigh. David, let me turn back to you. How can this legislation help people who are not on Medicare, who rely on expensive drugs, or will it?

[00:41:45] David Mitchell: Well first, the measure of price increases that will be used to determine if a company is raising prices faster than inflation will be a measure looking at the prices in both public programs and in the private sector. So drug companies actually under this legislation, under this law, have an incentive to hold the line on private sector price increases in order to avoid paying penalties to Medicare for increasing prices faster than the rate of inflation. Second, you know the private sector has a lot of power to negotiate and employers who provide coverage to about half of all Americans and insurers who administer those plans will know the inflation capped price, and the negotiated prices will be public on the drugs that are ultimately negotiated. And those private sector actors can use that information as leverage in their bargaining to say, hey, the price in Medicare is this much. I want that price matched. But we do have to do more to curb abusive pricing in the private sector, especially for drugs like insulin. There's more to do there.

[00:43:11] Bill Walsh: Yeah, yep. And, David, you touched on this a little bit a little bit earlier, this is a law, but it doesn't mean the drug companies will stop fighting it. What do you expect the drug companies to do next? Will they comply or have you seen signs they will try to undo this law?

[00:43:32] David Mitchell: Well, I'm, I'm old, and so I remember listening to Neil Young, I'm an AARP member, and he had an album called Rust Never Sleeps. And I kind of think of big pharma as rust. The drug companies have already said they will do everything in their power to try and block effective implementation of the law and generally gum up the works. They are threatening legal challenges and other procedural moves; that's why this fight is not over. And all of us are very lucky to have AARP in the vanguard having done all this hard work to help us pass this law, but now working hard to make sure that we implement it effectively so the law will, in fact, take effect as intended and benefit millions of Americans.

[00:44:36] Bill Walsh: Okay, now, David, one of the things that the drug companies have said consistently is that, you know, Medicare negotiating prices will stifle research in innovation. Is that true? Will we see fewer new drugs?

[00:44:53] David Mitchell: Well, first of all, stifle research and innovation. I told you that I have an incurable blood cancer; it's incurable because no drug works forever, and they're going to have to invent some new drugs for me, or I'm going to die sooner than I hope to. So nobody cares more about innovation in new drug development than patients like me. And we are not putting our lives at risk by getting prices that are affordable. First of all, people are dying now because they can't afford the drugs they need now. We've had people die from, you know, trying to ration their own insulin. We have patients in our community, Patients for Affordable Drugs, who forgo buying their drugs, taking the recommended dose, don't take the best drug that works most effectively for them because of the price. Right now, by lowering prices, we can improve the health of Americans with the drugs that are available, but not affordable. Second, the Congressional Budget Office, which is nonpartisan, doesn't have an ax to grind, looked at the impact of this new law and concluded that out of 1,300 new drugs anticipated in the next 30 years, this law might reduce that number by 15. It's a drop in the bucket, especially because most new drugs are not actually therapeutic advancements, there will be two drugs, they're copycat drugs, so we're talking about a negligible to nonexistent impact on innovation in new drug development. And then finally the inflation caps are going to help with this. Right now, drug companies, in order to meet profit targets and trigger executive bonuses, they raise prices on old drugs and they don’t invest to develop new, innovative drugs that could command a high price. We’re not going to let them do that anymore. And so if they want to make more money, they’re going to have to invent new, innovative drugs that will command, and should command, a high price. So this legislation is actually going to spur innovation and new drug development, not the other way around.

[00:47:26] Bill Walsh: All right. Thanks so much for that, David. Let’s go back to our listeners. It’s time now to address more of your questions with Leigh Purvis and David Mitchell. And as a reminder, press *3 at any time on your telephone keypad to be connected with an AARP staff member, or drop your question in the comments section on Facebook or YouTube. Jesse, who do we have next on the line?

[00:47:49] Jesse Salinas: Yeah, we’re going to bring in Diane from Georgia.

[00:47:53] Bill Walsh: Hey, Diane. How are you? Welcome to our program.

[00:47:56] Diane: Hey, good. How are you guys?

[00:47:57] Bill Walsh: Go ahead with your question. Very good. Go ahead.

[00:48:00] Diane: My question is this, my question is this: I have a friend who is on a very expensive insulin and is not currently, Medicare doesn’t cover it really right now. Is that going to fall under this new low cost, low copay on insulin. When that, and is that, does that, that starts next year? Is that correct?

[00:48:35] Bill Walsh: Yeah, Diane, can you give me a little more detail on the particular kind of insulin you’re talking about?

[00:48:41] Diane: I do not know the name.

[00:48:43] Bill Walsh: Okay, that’s okay. Well, let’s ask Leigh Purvis. Yeah, go ahead. Let me ask Leigh Purvis about coverage for insulin, and when that’s going to kick in. Leigh.

[00:48:54] Leigh Purvis: Sure, so as you heard, those insulin copay caps are going to kick in starting next year, but they will apply to the insulin that the particular plan covers, which really drives home the importance of during open enrollment, which is about a month away, making sure that you look at your Medicare Part D plan options and make sure that your specific insulin is covered by the plan that you are going to enroll in. It’s incredibly important because plans cover insulins, but they don’t necessarily cover all insulins. So you want to make sure that whatever plan you enroll in covers that insulin, and then you will get that $35 maximum copay.

[00:49:34] Bill Walsh: Okay, very good. Thanks so much, Leigh. Jesse, who do we have up next?

[00:49:40] Jesse Salinas: This is Glendia in Texas.

[00:49:45] Bill Walsh: Hey, how are you? Welcome.

[00:49:47] Glendia: Good morning.

[00:49:48] Bill Walsh: Hey, welcome to the program. Go ahead with your question,

[00:49:51] Glendia: Thank you. My question is everything is very interesting and everything, but is there a place I can go and review everything? I’m a diabetic person and most of my medication is very expensive, but I can’t keep in everything that’s been told today. Is there a place I can go to and read up on it?

[00:50:18] Bill Walsh: Yes, there sure is, Glendia. First of all, the program is being recorded and as of 24 hours from now, tomorrow, you'll be able to hear the whole thing again. You can also go to aarp.org and see the latest coverage of what's in the law and what it means for consumers. That coverage, there are dozens of articles there that touch on a lot of the information our two experts have provided today. And I believe there will also be a transcript of the program. A good site for you to go to is aarp.org/rx. Also, if you're an AARP member, keep an eye on the September AARP Bulletin, which is probably arriving in your mailboxes any day now. It has some extensive coverage of the new law and what it means for consumers. So I hope that helps. I don't know if Leigh or David want to provide any other tips.

[00:51:27] Okay, well, Jesse, let's go ahead with our next call.

[00:51:33] Jesse Salinas: Our next caller is Roger in Louisiana.

[00:51:37] Bill Walsh: Hey, Roger. Welcome to our program. Go ahead with your question.

[00:51:42] Roger: Yes, can you hear me?

[00:51:44] Bill Walsh: Yep, sure. Can go ahead with your question.

[00:51:47] Roger: Yeah, I was just, my question is, I know some of the medications are going to be negotiated next year, but I'm also baffled by the fact as to why it's going to be four years before any of the medications that they're going to review is going to be available to the public. That seems like a long time, four years, especially for those of us who may be in our 70s and 80s. And the other thing, I just...

[00:52:21] Jesse Salinas: Bill, we lost him, my apologies.

[00:52:23] Bill Walsh: Oh, I'm sorry. Sorry about that, Roger. But let's ask, let's pose your question. Roger wants to know; I mean he's asking a good question. Why is it taking four years for some of these provisions to kick in? Leigh, can you address that?

[00:52:34] Leigh Purvis: Yeah. And I get this question a lot, and I fully appreciate it as someone who has numerous family members who will definitely benefit from the provisions in this legislation. And I think the short answer is that the magnitude of the changes that are taking place here cannot be overstated. And it just takes some time to implement. For example, if you look at Medicare Part D plans, they are pretty much set for next year already. Open enrollment starts in about a month. So there are limitations on how many changes can take place without really disrupting the market. It's also really important to keep in mind, for example, when it comes to negotiation, this country has never negotiated at that scale. We're talking about 60-plus million people and they're going to be starting kind of from scratch in some ways. We've heard from administrators that it's going to, they need to fill like a hundred positions. It's just going to take some time to get this process up and running and you also need to build in some time to negotiate with those drug companies. So there are some provisions that are happening sooner, like the no-cost vaccines and the penalties for those increased prices and the copay caps, but I appreciate the frustration in this, and it's incredibly important, and that's why we've been so engaged on this issue. And it really just kind of reflects the fact that this has been a fundamental change and we're making it clear that we're no longer going to accept pricing on the basis of what the market will bear. And that's a big change and that takes some time. So while there are some provisions that will be happening sooner, the reality is it's going to take a few years to get these others off the ground. But the one thing I also like to remind people is that Medicare Part D, which we've mentioned a lot, the law that created Medicare Part D was enacted in November 2003, but it didn't become effective until January 2006. So historically speaking, the changes of this magnitude takes some time, but it often gets overlooked once those benefits really start kicking in. So patience, and important, big changes are coming.

[00:54:34] Bill Walsh: All right. Thanks very much for that, Leigh. Jesse, let's take another caller.

[00:54:38] Jesse Salinas: Our next caller is Carrie in Massachusetts.

[00:54:43] Bill Walsh: Hey, Carrie. Welcome to the program. Hey there, welcome to the program. Go ahead with your question.

[00:54:49] Carrie: I have a question regarding prescription hearing aids. Is Medicare going to start under this new Affordable Care Act, start paying part of the prescription for them and if not, why?

[00:55:03] Bill Walsh: Okay, good question. Leigh, can you address that? I know our colleague, Megan O’Reilly, said that AARP is still fighting for lower-cost hearing aids.

[00:55:14] Leigh Purvis: Yes, that was part of the discussion in the early days of this legislation. But unfortunately it did not make it into the final package. But AARP is very engaged on the fact that those over-the-counter hearing aids are going to become available and next month, or excuse me, in two months. And that is a way that there will be increased competition and they will start seeing some lower-cost hearing aids coming on the market. So that's going to be these people that have that low or moderate hearing loss, and that access will be greatly improved by having those over-the-counter hearing aids available to everyone.

[00:55:49] Bill Walsh: Let me follow up on that, Leigh. What about, what can you say about the quality of those over-the-counter hearing aids? Can consumers expect that they'll be as high quality as the ones they've been paying thousands of dollars for over the years?

[00:56:04] Leigh Purvis: It's hard to say, because the market's just kind of getting started. We certainly anticipate that people will be able to access hearing aids that help them. You can always go to your health care provider if you feel like you have concerns about what you've been able to obtain in that way. But we fully expect that for people who have that low to moderate hearing loss, these products will definitely provide a benefit.

[00:56:25] Bill Walsh: Very good. Thank you for that, Leigh. Jesse, let's take another listener question.

[00:56:30] Jesse Salinas: Our next caller is from Chuck in Virginia?

[00:56:34] Bill Walsh: Hey, Chuck, welcome to the program. Go ahead with your question.

[00:56:39] Chuck: Yes, my understanding and observation is that this only applies to those people that have the Part D coverage in some form. I have Medicare, I don't think doesn't pay anything for my drugs. I think Tricare pays my, that's my, you know, secondary, if you will. I don't know if that counts as a Part D, so I don't know that this is really addressing anything except those that are fortunate enough to have Part D coverage.

[00:57:28] Bill Walsh: Well, let's have Leigh Purvis address that. Leigh, you talked about the extent of the coverage today and who in Medicare would be eligible. Could you, could you talk about that again?

[00:57:38] Leigh Purvis: Sure. So I think it's safe to say that a lot of the provisions that are included in this law are specific to Medicare. So if you're a Medicare Part D plan, someone who's in a Medicare Part D plan, or someone who's in traditional Medicare and you have a prescription drug that's covered under Medicare Part B, you will benefit from that. But I think David's point earlier was very well taken, which is that these provisions will have larger implications than I think they seem when you first look at them kind of at their surface. Going back to those inflation-based rebates, the price metric that is used to evaluate whether a penalty needs to be paid is based on a price that's broadly applicable. To the extent that those negotiated prices are publicly available, we could see other insurers saying, hey, we want those prices too. And we're also expecting that a lot of the ideas that are very popular in this law, so things like the insulin copay caps or creating those hard out-of-pocket caps, are probably going to trickle down to other parts of the health care system. So even though these provisions may be specific to Medicare, the reality is they're going to have much more wide-reaching implications and hopefully will provide benefits for a lot more people.

[00:58:52] Bill Walsh: And, Leigh, let me just follow up. Chuck had mentioned Tricare. Would this affect people on, who rely on Tricare for their health insurance?

[00:59:02] Leigh Purvis: Again, to the extent that Tricare decides to kind of build on the provisions or replicate the provisions that are in the law, you could see some benefits. Again, these are very popular ideas and I think that a lot of insurers are going to be paying attention to what happens under Medicare and potentially try to find ways to do that themselves.

[00:59:20] Bill Walsh: Okay, well, thank you, Leigh. And thank you to David Mitchell as well. This has been a really informative discussion. I also want to thank you, our AARP members, volunteers and listeners for participating in the discussion today. AARP, a nonprofit, nonpartisan membership organization has been working to promote the health and well-being of older Americans for more than 60 years. All the resources referenced today, including a recording of the Q&A event, can be found at AARP.org/coronavirus on Sept. 8th, tomorrow. Go there if your question was not addressed, and you'll find the latest updates as well as information created specifically for older adults and family caregivers. Also, please join us on Sept. 15th for a live coronavirus Q&A event, and also on Sept. 22nd for a special live Q&A event with personal finance expert Suze Orman, who will join AARP's CEO, Joanne Jenkins, to address inflation and how to manage your money and cut costs. Thank you for joining us today and have a good day. This concludes our call.

Teleasamblea de AARP

La lucha para reducir los costos de los medicamentos recetados

 

 

Participan:

 

Leigh Purvis: directora de AARP para costos y acceso del cuidado de la salud

 

David Mitchell: presidente y fundador de Patients for Affordable Drugs

 

Megan O'Reilly: invitada especial, vicepresidenta, AARP

 

Jesse Salinas: organizador, vicepresidente, AARP

 

Bill Walsh: moderador, vicepresidente, AARP

 

 

Bill Walsh: Hola, Soy el vicepresidente de AARP, Bill Walsh y quiero darles la bienvenida a este importante debate sobre la lucha de AARP por reducir los precios de los medicamentos recetados. Antes de comenzar, si desean escuchar esta teleasamblea en español presionen *0 en el teclado de su teléfono ahora. AARP, una organización de membresía no partidista y sin fines de lucro, ha estado trabajando para promover la salud y el bienestar de los adultos mayores durante más de 60 años. Y durante gran parte de ese tiempo, AARP ha estado luchando arduamente en nombre de los adultos mayores para reducir los costos de los medicamentos recetados, y ha obtenido una victoria significativa.

 

Una ley aprobada en agosto ayudará a millones de adultos mayores a ahorrar dinero en sus medicamentos después de años de pagar los precios más altos del mundo. Si bien esta victoria es dulce, la lucha no ha terminado. AARP continuará luchando para garantizar que se implemente la ley y seguirá abogando por otras medidas para que los medicamentos recetados sean asequibles. Hoy escucharemos a un impresionante panel de expertos hablar sobre esta victoria histórica y lo que significa para ustedes. También recibiremos una actualización del Capitolio sobre esta legislación y lo que está haciendo AARP para continuar la lucha por reducir los precios de los medicamentos recetados. Si ya han participado en alguna de nuestras teleasambleas, saben que es similar a un programa de entrevistas de radio y tienen la oportunidad de hacer preguntas en vivo. Para aquellos de ustedes que nos acompañan por teléfono, si desean hacer una pregunta sobre la lucha para reducir los precios de los medicamentos recetados, presionen *3 en el teclado de su teléfono. Serán conectados con un miembro del personal de AARP que anotará su nombre y su pregunta y los colocará en una fila para hacer esa pregunta en vivo. Si participan por medio de Facebook o YouTube, pueden dejar su pregunta en la sección de comentarios.

 

Hola, si acaban de unirse, soy Bill Walsh, de AARP, y quiero darles la bienvenida a este importante debate sobre la lucha para reducir los precios de los medicamentos recetados. Hablaremos con principales expertos y responderemos sus preguntas en vivo. Para hacer una pregunta, presionen *3 en el teclado de su teléfono. Y si participan por medio de Facebook o YouTube, dejen su pregunta en la sección de comentarios. Tenemos algunos invitados destacados que nos acompañan hoy, incluido un especialista en políticas de salud pública y una experta en precios y cobertura de medicamentos recetados. También nos acompañará mi colega de AARP, Jesse Salinas, quien ayudará a facilitar sus llamadas. Este evento está siendo grabado y se podrá acceder a la grabación en aarp.org\elcoronavirus 24 horas después de que terminemos. Nuevamente, para hacer una pregunta, presionen *3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP. Y si participan por medio de Facebook o YouTube, dejen su pregunta en la sección de comentarios. Ahora me gustaría dar la bienvenida a nuestros invitados. Leigh Purvis es directora de AARP para costos y acceso del cuidado de la salud. Bienvenida al programa, Leigh.

 

Leigh Purvis: Muchas gracias por recibirme.

 

Bill Walsh: Muy bien. Muchas gracias por estar con nosotros. También tenemos aDavid Mitchell. David es el presidente y fundador del grupo sin fines de Patients for Affordable Drugs, que aboga por precios más bajos de medicamentos recetados. Bienvenido, David.

 

David Mitchel: Bill, muchas gracias. Encantado de estar aquí.

 

Bill Walsh: Muy bien, estamos encantados de tenerlos a ambos. Y solo un recordatorio para nuestros oyentes, para hacer una pregunta, presionen * 3 en el teclado de su teléfono o déjenla en la sección de comentarios en Facebook o YouTube. Muy bien, comencemos. Leigh, los esfuerzos para permitir que Medicare negocie los precios se han realizado durante décadas. ¿Por qué es esto tan importante para AARP y para los consumidores?

 

Leigh Purvis: AARP ha estado abogando por la negociación de Medicare durante casi 20 años, lo cual es sorprendente decir en voz alta. Nuestra perspectiva siempre ha sido que no tiene absolutamente ningún sentido para el programa de Medicare. Y son más de 16 millones de beneficiarios los que deben pagar precios de medicamentos recetados que se basan en gran medida en lo que soportará el mercado. Ahora que el beneficio de medicamentos recetados de Medicare o la Parte D se creó hace casi dos décadas, el proyecto de ley decía explícitamente que Medicare no podía negociar con las compañías farmacéuticas. Algunos planes de la Parte D pudieron negociar en nombre de sus afiliados. Así que se estaba negociando el precio, pero incluso los planes de medicamentos recetados más grandes no tienen la misma influencia que Medicare cuando negocia en nombre de todos los participantes del programa. Y es por eso que AARP ha estado presionando tanto para que negocie Medicare. El programa tendrá una increíble cantidad de poder en la mesa de negociación. Y eso conducirá a un trato mucho mejor para los beneficiarios de Medicare y los contribuyentes que ayudan a financiar el programa.

 

Bill Walsh: Gracias por eso, Leigh. Ahora, ¿puede proporcionar algunos ejemplos de medicamentos que podrían incluirse en las negociaciones?

 

Leigh Purvis: Claro. Y para que quede claro, hay algunos límites sobre los medicamentos que pueden ser aptos para la negociación. Por ejemplo, todos los medicamentos deben ser de una sola fuente, lo que significa que no debe haber competencia genérica en el mercado. Y los medicamentos más nuevos en el mercado no serán aptos para la negociación. Los medicamentos que serán aptos para la negociación solo se ingresarán al sistema si han pasado una cierta cantidad de años desde que fueron aprobados por la Administración de Medicamentos y Alimentos de EE.UU. Por lo tanto, algunos medicamentos de alto gasto que actualmente alcanzan esos umbrales incluyen medicamentos como Eliquis, que es un anticoagulante muy común, Januvia, que se usa para tratar la diabetes, y Xtandi, un medicamento que se usa para tratar el cáncer. Algunos otros medicamentos que hemos estado considerando que actualmente no alcanzan el umbral, pero que podrían alcanzarlo para cuando realmente comience la negociación, incluyen medicamentos como Imbruvica, que es para el cáncer, Jardiance, que es para la diabetes, y Eylea, que es para la degeneración macular relacionada con la edad, por lo que realmente estamos analizando un número muy amplio y un tipo de medicamentos que podrían calificar para la negociación en un futuro cercano.

 

Bill Walsh: Sí, y esos nombres probablemente sean bastante familiares para las personas que ven todos los anuncios en la televisión. Entonces me imagino que son medicamentos que consumen millones de personas en todo el país. Leigh, por supuesto, los beneficios de medicamentos recetados están incluidos en la ley llamada Ley de Reducción de la Inflación del 2022. ¿Qué disposiciones de esa ley serán más importantes para los beneficiarios de Medicare?

 

Leigh Purvis: En primer lugar, probablemente tendría que decir, como acabo de mencionar, las negociaciones de Medicare. También hay un nuevo límite de desembolso anual de $2,000 para las personas que tienen planes de medicamentos recetados. Y también hay sanciones para las compañías farmacéuticas que aumentan sus precios más rápido que la inflación. Y algo más que ha llamado mucho la atención es que los nuevos topes de copago mensual para la insulina son de $35, y eso ayudará a millones de beneficiarios de Medicare. Esta es una combinación realmente importante de disposiciones que abordarán esos altos gastos de bolsillo y los altos precios de los medicamentos recetados que los impulsan. Pero no quiero dejar nada afuera, esto es como elegir a un hijo favorito. Así que hay muchas otras disposiciones que creo que también ayudarán. Por ejemplo, a partir del próximo año, las vacunas recomendadas estarán disponibles sin costo en Medicare. Esto incluye vacunas como la de la culebrilla, que sabemos que pueden costar más de $300 de su bolsillo. Entonces, ese es un cambio realmente significativo para las personas que quizás han dudado en pagar por esa vacuna. También sabemos que muchas más personas calificarán para el programa de Ayuda Adicional de Medicare, que puede reducir significativamente los costos relacionados a los medicamentos recetados. Y las personas que tienen planes de medicamentos recetados de Medicare también podrán aminorar su costo repartido durante todo el año en lugar de enfrentar costos realmente altos durante un período corto. Entonces, otra forma de verlo es que realmente hay algo para casi todos.

 

Bill Walsh: Eso es genial. Muchas gracias, Leigh. Y profundizaremos en algunas de esas disposiciones más adelante en el programa, pero permítanme pasar a nuestro próximo invitado,David Mitchell. ¿Las aseguradoras privadas y la Administración de Veteranos no negocian ahora los precios con los fabricantes de medicamentos? ¿En qué se diferencia o se parece a lo que hará Medicare?

 

David Mitchel: Bueno, Medicare es el mayor comprador de medicamentos en Estados Unidos. Y como señaló Leigh hasta ahora, se ha prohibido expresamente usar ese poder adquisitivo para obtener un mejor trato para las personas. Y el enfoque que se tomará en las negociaciones es algo diferente de lo que hacen las aseguradoras privadas en la Administración de Veteranos, usan una estructura diferente para las negociaciones. Esta nueva ley establecerá un proceso que busca bajar los precios de todos los medicamentos que debería tener competencia, pero no la tienen y que les está costando a los pacientes y contribuyentes una cantidad desmesurada de dinero. Entonces, la estructura de la negociación, los objetivos de la negociación son algo diferentes, pero lo más importante es que las compañías farmacéuticas no querían tener nada que ver con nada de esto. Tenían una prohibición de que Medicare negocie directamente con las compañías farmacéuticas en el 2003, y han estado cabildeando, señaló Leigh, AARP ha estado librando esta lucha durante casi 20 años. Han estado gastando, las compañías farmacéuticas, cientos de millones de dólares en campañas para mantener esa prohibición y poder seguir dictaminando los precios de los medicamentos de marca para las personas del país. Bueno, este año, las personas se levantaron y dijeron, basta. AARP tomó la iniciativa en la lucha para que se aprobara esta legislación. Y ahora, de hecho, seremos capaces de hacer que ese poder de negociación de Medicare opere para millones de personas.

 

Bill Walsh: Muy bien, es genial escuchar eso. David, Leigh estaba hablando de algunos de los beneficios particulares. También quiero preguntarle por ellos. ¿Qué pasa con las personas que tienen cáncer u otras enfermedades que amenazan la vida? ¿Cómo les afecta esta legislación?

 

David Mitchel: Sí, bueno, yo soy una de esas personas, Bill. Tengo un cáncer de sangre incurable. Se llama mieloma múltiple. Y en este momento, mis médicos me recetan una combinación de cuatro medicamentos que tienen un precio de lista de más de $900,000 al año. Ahora, estoy muy agradecido por estos medicamentos. Me mantienen con vida, literalmente. Pero son tremendamente caros. Y están caros porque las compañías farmacéuticas utilizan todo tipo de tácticas para bloquear la competencia, para extender sus monopolios, los comportamientos abusivos exactos que esta legislación, al atacar estos medicamentos que han estado en el mercado durante mucho tiempo, que deberían tener competencia, pero no pretenden abordar. Solo uno de mis medicamentos bajo la Parte D de Medicare, un medicamento oral, un medicamento de quimioterapia, me cuesta más de $16,000 al año de mi bolsillo. Ahora, Leigh señaló que, por primera vez, habrá un límite de gastos de bolsillo para los beneficiarios de Medicare de $2,000 al año, esto será transformador para mí y para millones de otros pacientes con cáncer con el tiempo porque en lugar de estar a merced de algún tope de desembolso personal que pueda conducir a, ya sabe, tanto como yo estoy pagando más de $16,000 al año, de repente, eso se reducirá cuando la ley entre en vigencia por completo, a $2,000. Este es un gran problema. Y los límites de inflación en los aumentos de precios nos afectarán a todos al mantener la línea y detener el aumento de precios por parte de las compañías farmacéuticas.

 

Bill Walsh: Sí. Bueno, eso es tremendo. Ese es un impacto en el mundo real que no solo lo beneficiará a usted, David, sino a millones de personas con Medicare. Gracias por eso. Y como recordatorio para nuestros oyentes, para hacer su pregunta a nuestro panel de expertos, presionen *3 en el teclado de su teléfono. Y vamos a llegar a esas preguntas en vivo en breve. Pero antes de hacerlo, quiero traer a Megan O'Reilly. Megan es la vicepresidenta de Defensa de la Salud y la Familia, de AARP, y va a actualizar a nuestros oyentes sobre cómo AARP está luchando por ellos en el Capitolio. Bienvenida, Megan.

 

Megan O’Reilly: Feliz de estar aquí, Bill.

 

Bill Walsh: En primer lugar, felicitaciones a AARP, así como a los muchos voluntarios y socios de AARP en todo el país que lucharon arduamente durante tantos años para hacer realidad la baja de precios de los medicamentos.

 

Megan O’Reilly: Gracias, estamos encantados con la aprobación de esta legislación histórica, que es realmente una victoria para todos los adultos mayores. Después de décadas de pedirle al Congreso que haga que los medicamentos recetados sean más asequibles, AARP ha ganado la lucha para que Medicare negocie precios de medicamentos más bajos y ayude a las personas mayores a ahorrar dinero en sus medicamentos.

 

Bill Walsh: Muy bien, volviendo al principio, ¿por qué AARP está involucrada en la lucha para reducir los precios de los medicamentos recetados?

 

Megan O’Reilly: Una de las cosas que más escuchamos de nuestros socios es la frustración y la desesperación que surge al tratar de pagar los precios exorbitantes de los medicamentos recetados. La razón más común por la que las personas mayores no toman los medicamentos o los racionan es porque no pueden pagarlos. Y dejar que Medicare negocie precios de medicamentos más bajos es una solución de sentido común. Reforzará Medicare y, junto con el nuevo límite de gastos de bolsillo y la Parte D, devolverá dinero a los bolsillos y, al mismo tiempo, a las personas mayores que luchan para pagar el costo creciente de los medicamentos y otras necesidades básicas.

 

Bill Walsh: Bien, y como mencioné antes, estamos hablando específicamente de la Ley de Reducción de la Inflación del 2022, que fue aprobada tanto por la Cámara de Representantes como por el Senado y luego promulgada el 16 de agosto. ¿Cuáles son algunos de los elementos importantes incluidos en este proyecto de ley que AARP luchó para hacer realidad?

 

Megan O’Reilly: Tanto Leigh como David han mencionado algo de eso, pero déjeme explicar esto una vez más. La legislación va a permitir que Medicare negocie por primera vez algunos de esos medicamentos con los precios de costo más altos que están tomando millones de adultos mayores. El proyecto de ley también comenzará en el 2025, como hemos mencionado, y establecerá un límite estricto de $2,000 sobre cuánto tendrá que pagar una persona mayor en la Parte D de su bolsillo por sus medicamentos. Y va a penalizar a los fabricantes de medicamentos que aumenten esos precios más rápido que la tasa de inflación a partir de este año. Y finalmente, la nueva ley limita el costo de la insulina cubierta por Medicare a $35 por mes y elimina los gastos de bolsillo para la mayoría de las vacunas, como la de la culebrilla, con Medicare. Este proyecto de ley les ahorrará a las personas mayores y a Medicare cientos de miles de millones de dólares y les dará la tranquilidad de saber que hay un límite anual en lo que deban pagar de su bolsillo por medicamentos.

 

Bill Walsh: Bien, Megan, esas son muchas disposiciones. ¿Puede hablar sobre cuándo los consumidores verán que se están produciendo algunos de estos cambios?

 

Megan O’Reilly: Claro. Hay algunos que serán inmediatos y otros que llevará algunos años implementar. A fines de este año, las compañías farmacéuticas que aumenten los precios de sus productos más rápido que la tasa de inflación tendrán que comenzar a pagar reembolsos, multas al Gobierno. Al comienzo del próximo año, los copagos de insulina y Medicare tendrán un tope de $35. Y las personas con Medicare ya no tendrán que pagar ninguna vacuna recomendada, como mencioné, la de la culebrilla. Otras mejoras ahorrarán dinero a las personas mayores y a Medicare, como los límites en los pagos de bolsillo en la Parte D y el requisito de que Medicare negocie, que entrará en vigencia en los años siguientes.

 

Bill Walsh: Bueno, todas esas son buenas noticias. Esta es una victoria histórica. ¿Qué sigue para AARP?

 

Megan O’Reilly: Esta es una gran victoria, pero como dijo, la lucha no ha terminado. Sabemos que las grandes compañías farmacéuticas gastarán millones para intentar anular o socavar la nueva ley para poder seguir cobrando a las personas los precios más altos del mundo. AARP seguirá luchando contra los precios descontrolados de las grandes compañías farmacéuticas, y no retrocederemos. Nuestra principal prioridad es ver que se implementen estos cambios y hacer más para garantizar que las personas mayores puedan pagar sus medicamentos.

 

Bill Walsh: Muy bien, bueno, es genial escuchar eso. Megan, tal vez podamos hablar sobre algunas de las otras prioridades de salud por las que AARP está luchando.

 

Megan O’Reilly: AARP está luchando por muchas formas de proteger la salud de los adultos mayores. En este momento, estamos luchando por la salud de los cuidadores familiares y trabajando para brindarles a las personas mayores un mayor acceso a la atención domiciliaria y más protecciones en los hogares de ancianos. También estamos luchando por la cobertura dental en Medicare. Hemos intervenido con éxito con los Centros de Servicios de Medicare y Medicaid para ampliar cuándo Medicare cubrirá la atención dental cuando esté vinculada a otra enfermedad cubierta por el programa de Medicare. Y vamos a seguir abogando por una cobertura dental más amplia, así como atención de la vista y la audición. Hemos abogado por la nueva regla sobre audífonos de venta libre que se publicó el mes pasado. Los audífonos de menor costo ahora estarán disponibles para aquellos con pérdida auditiva de baja a moderada a partir de octubre. Esto se produce después de años de trabajo bipartidista de AARP con el Congreso y la administración para ampliar el acceso a audífonos de menor costo. También continuamos luchando para permitir un mayor uso de la telesalud, trabajando para resolver el hambre y la inseguridad alimentaria de las personas mayores. Estamos abogando por la cobertura de salud mental y luchando para ampliar el acceso a una atención médica asequible. AARP está luchando arduamente para mejorar su atención médica y su calidad de vida.

 

Bill Walsh: Muy bien, Megan, gracias. Es un trabajo muy importante. Y, por supuesto, AARP no podría hacerlo sin sus millones de socios y voluntarios que trabajan con AARP y en su nombre. Entonces, felicitaciones a todos los participaron en lo que sé que ha sido una lucha de una década para que esto suceda. Megan, finalmente, si nuestros oyentes quieren estar al tanto de las noticias de defensa de derechos de AARP, ¿cómo pueden enterarse de las últimas actualizaciones?

 

Megan O’Reilly: Claro. Alentamos a todos a conectarse en línea y buscar AARP Fighting For You. Eso los llevará a un resumen diario de las últimas noticias y actualizaciones sobre nuestro trabajo con el Congreso y en todo el país. Es realmente una excelente manera de mantenerse informados y esperamos que lo busquen.

 

Bill Walsh: Muy bien, buscar en internet AARP Fighting For You. Muchas gracias, Megan, por estar con nosotros hoy. Realmente lo aprecio.

 

Megan O’Reilly: Gracias, Bill.

 

Bill Walsh: Muy bien. Ahora es el momento de abordar sus preguntas sobre las disposiciones sobre medicamentos recetados de la Ley de Reducción de la Inflación con Leigh Purvis y David Mitchell. Opriman *3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP para compartir su pregunta en vivo. Si desean escuchar este programa en español, presionen *0 en el teclado de su teléfono ahora. Bien, y en este momento me gustaría traer a mi colega de AARP, Jesse Salinas, para ayudar a facilitar sus llamadas. Bienvenido, Jesse.

 

Jesse Salinas: Muy contento de estar aquí, Bill.

 

Bill Walsh: Muy bien, ¿de quién es nuestra primera llamada?

 

Jesse Salinas: Nuestra primera llamada hoy es de Paul en California.

 

Bill Walsh: Hola, Paul, bienvenido a nuestro programa. Adelante con su pregunta.

 

Paul: Buenos días. Gracias por tomar nuestras preguntas. Entonces, hace unas dos semanas, después de que se aprobó la ley, estaba viendo uno de los canales de noticias por cable y uno de los comentaristas, Chris Wallace, dijo que, de hecho, solo 10 medicamentos estarán sujetos a negociación. Y dijo que la información proporcionada sugería que se estaría considerando una cantidad mucho mayor de medicamentos. ¿Es cierto que solo 10 medicamentos están sujetos a negociación por parte de Medicare?

 

Bill Walsh: Gracias por esa pregunta, Paul. Preguntemos a nuestros expertos. Leigh, abordó esto hace un momento. ¿Puede ampliar eso y responder la pregunta de Paul?

 

Leigh Purvis: Absolutamente. Y gracias por la pregunta. Es una buena pregunta. La negociación en realidad se va a introducir gradualmente con el tiempo. Ese primer año, cuando los precios estén disponibles en el 2026, se verán 10 medicamentos. Sin embargo, en el 2027 habrá 15 medicamentos, en el 2028 habrá otros 15 medicamentos. Y en el 2029, habrá 20 medicamentos y más. Entonces, lo que eso significa es que se pueden negociar hasta 60 medicamentos para el 2029. Y ese número será acumulativo. Entonces, aunque puede haber, cito, solo 10 medicamentos en ese primer año, que recuerden que se trata de iniciar un programa grande, se agregarán otros medicamentos con el tiempo. Entonces, en última instancia, podrían agregarse muchos más medicamentos en los próximos años.

 

Bill Walsh: Genial. Muchas gracias, Leigh, por eso. Jesse, ¿de quién es nuestra próxima llamada?

 

Jesse Salinas: Vayamos con James de Pensilvania.

 

Bill Walsh: Hola, James, bienvenido a nuestro programa. Adelante con su pregunta. Hola James, sigue adelante con su pregunta.

 

James: Hola, soy James.

 

Bill Walsh: Hola, James, ¿cómo está?

 

James: Bien.

 

Bill Walsh: Adelante. Continúe con su pregunta para nuestro panel.

 

James: Déjeme hacer una pregunta. ¿Qué pasó con el período sin cobertura del que hablamos con Medicare en la Parte D?

 

Bill Walsh: Sí, esa es una pregunta válida. Estoy seguro de que nuestros oyentes están muy familiarizados con el período sin cobertura en Medicare. David Mitchell, ¿puede hablar un poco sobre eso?

 

David Mitchel: Voy a intentarlo. Leigh lo sabe mejor que yo. Pero ya no hay un período, es lo que respondería a esa pregunta. La estructura de los copagos, creo, y, Leigh, vas a corregirme si me equivoco, seguirá habiendo un deducible que todos pagamos. Y luego pagaremos el 20 o el 25% del precio de lista de los medicamentos que necesitemos hasta que sea completamente efectivo, hasta no más de $2,000. No habrá más período sin cobertura, y no habrá más pagos catastróficos. La razón por la que mis medicamentos son tan increíblemente caros para mí es que, según la ley actual, cuando llega al llamado nivel catastrófico, paga el 5% de la lista hasta el 31 de diciembre. Bueno, como mi medicamento cuesta $21,000, cada 28 días, llego a ese 5%. Vamos a hacer que ese pago catastrófico del 5% desaparezca y dejarlo en $2,000 al año y no habrá más período sin cobertura. ¿Lo expliqué bien, Leigh?

 

Leigh Purvis: Como siempre, David, tiene toda la razón. Sí, la brecha de cobertura finalmente desaparecerá, se eliminará, lo cual sé que es una buena noticia para mucha gente. La estructura de beneficios en sí cambiará en el 2025 como parte de ese nuevo límite de gasto personal. Y parte de eso trata de deshacerse de la brecha de cobertura, que técnicamente aún existía, pero se había cubierto con una serie de descuentos, y ahora esa parte del beneficio desaparecerá. Así que la gente ya no tiene que preocuparse por la falta de cobertura.

 

Bill Walsh: Bueno, eso es fantástico. Y para que quede claro, Leigh, ese límite de gastos de bolsillo de $2,000 entrará en vigencia, ¿es en el 2025?

 

Leigh Purvis: Eso es correcto.

 

Bill Walsh: Genial. Bien, gracias a los dos por esa información. Oh, adelante, David.

 

David Mitchel: Creo que es importante agregar que en el 2024, comenzará a reducirse y el desembolso máximo que un paciente como yo puede pagar y se reducirá a aproximadamente $3,000 o $4,000 y luego en el 2025 se reducirá a $2,000 con la implementación total de la ley. Entonces, comenzaremos a ver cómo disminuyen los desembolsos máximos a partir del 2024.

 

Bill Walsh: Va a ser una gran tranquilidad para las personas saber que no entrarán en bancarrota debido al costo de sus medicamentos. Muchas gracias a los dos. Jesse, ¿a quién tenemos ahora en la línea?

 

Jesse Salinas: Sí, nuestra próxima pregunta es de YouTube. Es de Becky. Y ella dice: "He leído que habrá un deducible hacia los costos de desembolso de $2,000. ¿En qué afectará eso las opciones en la Parte D de Medicare y/o los costos de las primas?"

 

Bill Walsh: Leigh, ¿puede contestar esa pregunta?

 

Leigh Purvis: Sí, esa es otra buena pregunta. Sí, cualquier gasto de bolsillo en el que incurra contará para ese límite de gastos de bolsillo de $2,000. Lo importante que debemos tener en cuenta a medida que ocurren todos estos cambios es que en realidad hay otra disposición dentro de la Ley de Reducción de la Inflación que no hemos discutido, que limita cuánto puede aumentar la prima cada año. Y eso comenzará en el 2024, continuará hasta el 2029 y podría ir aún más lejos, dependiendo de cómo se maneje todo esto. Entonces, no solo verán reducciones en sus gastos de bolsillo, sino que también estarán protegidos ante cualquier aumento de primas, o grandes aumentos de primas, debería decir, que pueden resultar de todos los cambios que están teniendo lugar en tan poco tiempo.

 

Bill Walsh: Muchas gracias, Leigh. Y para nuestros oyentes, sé que hay muchos detalles aquí y pueden volverse confusos muy rápido. Si están interesados en leer más y mantenerse actualizados, pueden visitar aarp.org y ver los artículos que nuestro personal está escribiendo sobre la nueva ley, lo que significa, etcétera. Volvamos a las líneas. Jesse, ¿a quién tenemos ahora?

 

Jesse Salinas: Sí, tengo una pregunta más de Facebook. Y dice: "¿Cómo proporciona Canadá medicamentos recetados a un costo tan bajo en comparación con EE.UU.?"

 

Bill Walsh: David, ¿puede abordar esa pregunta?

 

David Mitchel: Bueno, Canadá ha estado haciendo efectivamente lo que vamos a empezar a hacer, como resultado de las disposiciones sobre precios de medicamentos en la Ley de Reducción de la Inflación. Ha negociado directamente con las compañías farmacéuticas sobre los precios. La otra razón, francamente, es porque Canadá tiene un programa de salud administrado por el Gobierno, tal vez sea la forma de decirlo. Negocia los precios de los medicamentos para todas las personas del país. Y así lo ha hecho en cuanto a negociar y decir, no vamos a aceptar el precio, no vamos a dejar que nos digan el precio, las compañías farmacéuticas, y luego lo pagaremos, sea lo que sea. Canadá ha estado negociando desde el principio. Vamos a empezar a negociar ahora en Estados Unidos, y como ha señalado Leigh al principio, esto se ha retrasado mucho. Esta es una lucha que ha durado 20 años para tratar de poder usar el poder adquisitivo de Medicare para obtener un mejor trato para todos nosotros.

 

Bill Walsh: Está bien, muy bien. Jesse, ¿a quién tenemos ahora?

 

Jesse Salinas: Sí, Bill. Nuestra próxima pregunta será de Mary en Texas.

 

Bill Walsh: Hola, Mary, bienvenida a nuestro programa. Continúe con su pregunta.

 

Mary: Me preguntaba cuándo iba a bajar el precio de Eliquis.

 

Bill Walsh: Bien, preguntémosle a Leigh Purvis sobre eso. Leigh, ¿tenemos alguna idea de eso todavía? ¿O ese tipo de detalles muy específicos se resolverán más adelante? ¿Qué puede decirle a Mary?

 

Leigh Purvis: Claro. Otra buena pregunta, porque todos, por supuesto, están muy interesados ​​ en escuchar acerca de los medicamentos que están tomando. Para el otoño del próximo año sabremos qué 10 medicamentos planea negociar Medicare para que los precios negociados estén disponibles en el 2026. Eliquis ciertamente está en la lista considerando cuánto gasta Medicare en él. Pero la pregunta será si calificará en función de todos los criterios que deben cumplirse antes de que se negocie. Así que definitivamente diría que lo estamos observando, ya que probablemente sea un competidor, pero no podemos decir con seguridad si será uno de los medicamentos negociados que estarán disponibles en el 2026.

 

Bill Walsh: Bueno. Muchas gracias. Jesse, ¿a quién tenemos ahora?

 

Jesse Salinas: Sí, tengo a Amy en Pensilvania.

 

Bill Walsh: Hola, Amy, bienvenida a nuestro programa. Adelante con su pregunta.

 

Amy: Sí, hola. Tengo parientes que están en Medicare regular con la Parte D, Medicare regular sin la Parte D y Medicare Advantage, obviamente, las personas que no tienen la Parte D no se van a beneficiar de esto, supongo, pero ¿Medicare Advantage y los participantes regulares de Medicare se benefician de la misma manera? ¿Y también cuándo será Shingrix gratis? Conozco gente que no lo está tomando por el gasto.

 

Bill Walsh: Está bien. Leigh, ¿puede responder esas preguntas?

 

Leigh Purvis: Claro, comenzaré con Shingrix porque ese es súper fácil. Eso será a partir del próximo año. Entonces, en el 2023, las vacunas contra la culebrilla no tendrán costo. Así que definitivamente podrán ir y recibirlas. La otra pregunta sobre dónde se aplican estas disposiciones, en realidad es mucho más amplia de lo que parece. Por ejemplo, para la negociación, los precios de los medicamentos bajo la Parte D de Medicare, que es de lo que hemos estado hablando. Pero también se incluirá la Parte B de Medicare. Por lo tanto, todos los medicamentos que cubre Medicare se incluirán en la negociación y posiblemente se negocien. Cuando hablamos de las disposiciones que son específicas de la Parte D de Medicare, están disponibles tanto para las personas en el plan independiente de la Parte D de Medicare, es decir las personas con Medicare tradicional y el plan de la Parte D, como para las personas que tienen Medicare Advantage con la Parte D. Entonces, las personas que están en Medicare Advantage y también obtienen su cobertura de medicamentos recetados de ese plan. Algo más para mencionar también son, por ejemplo, esas multas por inflación en donde las compañías farmacéuticas tienen que pagar una multa cuando su precio aumenta más rápido que la inflación, que también se aplican a todos los medicamentos que están cubiertos por Medicare. Entonces, la realidad es que Medicare realmente está tomando y desempeñando un papel en muchos medicamentos recetados. Entonces, independientemente de cómo uno esté cubierto por Medicare, verá algunos beneficios.

 

Bill Walsh: Genial, eso es muy útil. Gracias, Leigh. Jesse, ¿a quién tenemos ahora en la línea?

 

Jesse Salinas: Nuestra próxima llamada es Laurie de Míchigan.

 

Bill Walsh: Hola, Laurie, bienvenida a nuestro programa. Adelante con su pregunta.

 

Laurie: Muy bien, gracias. Me gustaría saber qué otras vacunas podrían estar cubiertas además de Shingrix.

 

Bill Walsh: Leigh, ya que recién estabas hablando de vacunas, ¿quiere seguir hablando de eso? ¿Cuáles otras estarían cubiertas?

 

Leigh Purvis: La de la culebrilla fue la que más buscamos porque somos muy conscientes de las barreras de costos que existían en el pasado. Cuando hablamos de vacunas recomendadas, son aquellas que el Comité Asesor para Prácticas de Inmunización, ACIP, que forma parte de los Centros para el Control de Enfermedades, ha recomendado para adultos. Así que tenemos que ver esas recomendaciones. Creo que otras que se han mencionado incluyen la del tétanos. Creo que es importante diferenciar que los planes de la Parte D de Medicare tienen que cubrir todas las vacunas disponibles comercialmente que no están cubiertas por la Parte B de Medicare, que cubren otras como las de la gripe o la neumonía. Por lo tanto, habrá algunas vacunas, potencialmente algunas, que no necesariamente estarán cubiertas por esta nueva disposición sin costo alguno. Por eso es importante echar un vistazo a lo que ACIP ha recomendado para adultos. Y esos son los que van a estar cubiertos por esta disposición.

 

Bill Walsh: Está bien, muy bien. Gracias, Leigh. Jesse, tomemos otra pregunta de uno de nuestros oyentes. ¿Quién sigue?

 

Jesse Salinas: Sí, vamos a tomar esta pregunta de Facebook. Estamos recibiendo muchas preguntas similares a esta, Bill. ¿Por qué no ha habido ninguna discusión sobre los cupones de descuento que aparentemente las compañías farmacéuticas están financiando y no comienzan con algunos precios de prescripción honestos en su lugar?

 

Bill Walsh: David, ¿puede abordar esa pregunta?

 

David Mitchel: Wow, esa es una gran pregunta. La gente generalmente no entiende que las compañías farmacéuticas no dan cupones de descuento para ayudar a los pacientes. Dan cupones de descuento para vender más medicamentos a precios cada vez más altos. De hecho, afirman que se trata de obras de caridad, contribuciones de caridad para ayudar a los pacientes que no pueden pagar sus medicamentos. No es verdad. Obtienen ganancias con esos cupones. ¿Por qué? Porque si pueden darle un cupón para cubrir el 10% del costo que tendría que pagar de su bolsillo y cobran el 90% del precio de Medicare, y siguen subiendo el precio, ganan mucho dinero al usar cupones de descuento para que el desembolso desaparezca y duela menos. Es por eso que Medicare no permite cupones, cupones de descuento, cupones de copago. Son vistos como un soborno ilegal, un incentivo para comprar un producto que no está permitido por Medicare. Entonces, lo que hacen las compañías farmacéuticas es hacer donaciones a organizaciones benéficas, las llamadas organizaciones benéficas, y destinan la donación a una enfermedad específica. Pero la compañía farmacéutica sabe cuánta participación de mercado tiene para esa enfermedad con su propio medicamento. Entonces, si se trata de la enfermedad X, y saben que tienen el 90% del mercado del medicamento que se usa para tratar esa enfermedad, ese 90% de lo que dan se lo devolverán. Así que todas esas cosas, los cupones de copago, las llamadas organizaciones benéficas para cubrir los desembolsos, son todas estafas para gastar más dinero, para cobrar más dinero por los medicamentos. Lo que tenemos que hacer es lo que dijo la persona que hizo la pregunta, que es que tenemos que bajar los precios para que sean justos, de modo que los medicamentos sean asequibles y accesibles, no depender de trucos, como cupones de copago, y es uno de los problemas que tenemos, para seguir trabajando en esa dirección.

 

Bill Walsh: Ahora, David, déjeme continuar. Dada la aprobación de esta nueva ley, ¿se espera que los consumidores sigan viendo ofertas de descuento de las compañías farmacéuticas?

 

David Mitchel: Sí, porque no hicimos ningún cambio a la ley en este sentido. Y vamos a tener que seguir trabajando para llegar a un punto en el que realmente estemos ofreciendo medicamentos que sean asequibles y accesibles para las personas y no depender de trucos y estafas, son estafas. Ya sabe, estas compañías farmacéuticas usan cupones para vender más medicamentos de la misma manera, ya sabe, el fabricante de Clorox intenta vender más Clorox. No se trata de caridad. No se trata de ayudar a la gente. Se trata de obtener más ganancias a costa nuestra. Entonces necesitamos bajar los precios y dejar de usar cupones de descuento.

 

Bill Walsh: Está bien, muy bien. Gracias a nuestros panelistas y gracias a quienes llamaron. Vamos a tomar más preguntas de las personas que llaman en breve. Ahora es el momento de abordar más de sus preguntas con Leigh Purvis y David Mitchell. Si desean hacer una pregunta, presionen *3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP para ponerse en la fila para hacer esa pregunta en vivo. Leigh, déjeme preguntarle esto. Esto salió en una de las llamadas. ¿Cuándo pueden las personas esperar ver precios más bajos? Eso es lo que está en la mente de la mayoría de la gente. ¿Puede indicarnos el cronograma para el lanzamiento?

 

Leigh Purvis: Una pregunta completamente entendible. Mencioné anteriormente que Medicare comenzará a negociar en los próximos años. Entonces, como mencioné, Medicare elegirá esos primeros 10 medicamentos que se negociarán para esta fecha el próximo año. Y esos primeros precios negociados estarán disponibles en el 2026. Y luego, los precios negociados adicionales estarán disponibles todos los años a partir de ese momento. Entonces, más específicamente, y nuevamente, como mencioné, Medicare negociará los precios de otros 15 medicamentos en el 2027 y el 2028, y otros 20 medicamentos en el 2029 y más allá. Entonces, nuevamente, eso podría significar que hasta 60 medicamentos podrían tener un precio negociado para el 2029. Pero la otra cosa que no podemos pasar por alto es la disposición que permite multas para las compañías farmacéuticas que aumentan sus precios más rápido que la inflación. Las compañías farmacéuticas comenzarán a enfrentar esas sanciones a fines de este año. Y si bien esas sanciones no conducirán necesariamente a precios más bajos de los medicamentos, desalentarán a las compañías farmacéuticas de aceptar esos aumentos de precios increíblemente altos de los que escuchamos año tras año. Y eso también ayudará con la asequibilidad. Por lo tanto, hay una serie de disposiciones que abordarán el precio que se implementará en los próximos años. Y con suerte la gente verá algunos cambios pronto.

 

Bill Walsh: Ahora, Leigh acaba de hablar sobre si el precio de un medicamento supera la inflación, ¿qué sucede entonces? ¿Qué tan altas son las sanciones de las que estamos hablando? Y, ya sabe, ¿Medicare tendrá la autoridad para obligar a bajar el precio por debajo de la inflación?

 

Leigh Purvis: Sí, bueno, los fabricantes de medicamentos tendrán la capacidad de negarse a negociar, pero estarán sujetos a un impuesto especial muy alto y en aumento, que equivaldrá a un cierto porcentaje de todas sus ventas durante el tiempo que no están cumpliendo. En efecto, ese impuesto especial podría resultar básicamente en multas que son más altas que el precio que están cobrando, puede llegar a ser extremadamente alto. Así que efectivamente, las compañías farmacéuticas estarían pagando para tener sus productos en el mercado. Entonces, la expectativa es que este impuesto proporcione un incentivo extremadamente fuerte para que las compañías farmacéuticas participen en todo el proceso de negociación.

 

Bill Walsh: Está bien, tanto para participar como para mantener los precios de sus medicamentos por debajo de la tasa de inflación.

 

Leigh Purvis: Absolutamente. Se fomentará mucho.

 

Bill Walsh: Está bien, muy bien. Y, por último, Leigh, permítame preguntarle acerca de todos estos cambios de los que estamos hablando, ¿reducirán los costos de los medicamentos para las personas o solo estamos hablando de ahorros para el programa Medicare?

 

Leigh Purvis: Eso es lo que hace que esta sea una victoria tan increíble, al menos desde mi perspectiva porque la respuesta es ambas cosas. Las cosas de las que ya hemos hablado, como la negociación de Medicare, el nuevo límite de gastos de bolsillo para las personas y los planes de medicamentos recetados, multas para las compañías farmacéuticas que aumentan sus precios más rápido que la inflación, los límites de copago para la insulina, vacunas sin costo, costos compartidos, que ahora se pueden repartir durante todo el año. Eso ayudará a reducir los costos relacionados con los medicamentos recetados para decenas de millones de beneficiarios de Medicare. Además, aquellos beneficiarios de Medicare que aún no han alcanzado su deducible, o que están pagando un porcentaje de los costos de sus medicamentos, lo que se conoce como coseguro, verán un beneficio directo de la caída de los precios de los medicamentos. Y luego aludimos a algunos de los cambios en el beneficio de la Parte D de Medicare, que son menos visibles, pero Medicare pagará menos por las personas que alcancen una cobertura catastrófica. Y esa ha sido una gran parte de los gastos de Medicare últimamente. Eso ayudará a reducir los gastos de Medicare además de los gastos reducidos relacionados con los precios más bajos de los medicamentos recetados. Entonces, entre eso, las negociaciones, las sanciones por los aumentos de precios y todas las demás disposiciones de la ley, creo que Megan mencionó que la Oficina de Presupuesto del Congreso no partidista ha estimado que Medicare ahorrará cientos de miles de millones de dólares durante los próximos 10 años, lo que obviamente es una gran victoria para ambos beneficiarios y los contribuyentes que están ayudando a financiar el programa.

 

Bill Walsh: Muy bien. Muchas gracias, Leigh. David, déjeme volver a usted. ¿Cómo puede ayudar esta legislación a las personas que no tienen Medicare y que dependen de medicamentos costosos? O ¿lo hará?

 

David Mitchel: Bueno, primero, la medida de los aumentos de precios que se usará para determinar si una empresa está aumentando los precios más rápido que la inflación será una medida que analice los precios tanto en los programas públicos como en el sector privado. Entonces, las compañías farmacéuticas en realidad, según esta legislación, según esta ley, tienen un incentivo para mantener el control sobre los aumentos de precios del sector privado, para evitar pagar multas a Medicare por aumentar los precios más rápido que la tasa de inflación. En segundo lugar, el sector privado tiene mucho poder para negociar. Y los empleadores que brindan cobertura a aproximadamente la mitad de todas las personas, y las aseguradoras que administran esos planes, sabrán el precio tope de inflación, y los precios negociados serán públicos en los medicamentos que finalmente se negocien. Y esos actores del sector privado pueden usar esa información como ventaja en su negociación para decir, oye, el precio en Medicare es tanto, quiero que se iguale el precio. Pero tenemos que hacer más para frenar el abuso de precios en el sector privado, especialmente para medicamentos como la insulina, hay más por hacer allí.

 

Bill Walsh: Sí. Sí. Y, David, mencionó este tema hace un momento. Esta es una ley, pero no significa que las compañías farmacéuticas dejarán de luchar contra ella. ¿Qué espera que hagan las compañías farmacéuticas a continuación? ¿Cumplirán? ¿O han visto señales de que intentarán deshacer esta ley?

 

David Mitchel: Bueno, soy viejo y recuerdo haber escuchado a Neil Young. Soy socio de AARP y él tenía un álbum llamado Rust Never Sleeps, y creo que las grandes farmacéuticas están oxidadas. Las compañías farmacéuticas ya han dicho que harán todo lo que esté a su alcance para tratar de bloquear la implementación efectiva de la ley y, en general, entorpecer los trabajos. Están amenazando con desafíos legales y otros movimientos procesales. Por eso esta lucha no ha terminado. Y todos somos muy afortunados de tener a AARP a la vanguardia, habiendo hecho todo este arduo trabajo para ayudarnos a aprobar esta ley, pero ahora trabajando arduamente para asegurarnos de que la implementemos de manera efectiva para que la ley, de hecho, entre en vigencia como está previsto y beneficie a millones de personas.

 

Bill Walsh: Bien, ahora, David, una de las cosas que las compañías farmacéuticas han dicho continuamente es que los precios de negociación de Medicare frenarán la investigación en innovación. ¿Es eso cierto? ¿Veremos menos fármacos nuevos?

 

David Mitchel: Bueno, en primer lugar, frenar la investigación y la innovación. Les dije que tengo un cáncer de sangre incurable. Es incurable porque ningún medicamento funciona para siempre. Y van a tener que inventar algunos medicamentos nuevos para mí, o moriré antes de lo que espero. Así que a nadie le importa más la innovación y el desarrollo de nuevos fármacos que a pacientes como yo. Y no estamos poniendo en riesgo nuestra vida al obtener precios asequibles. En primer lugar, la gente se está muriendo ahora porque no pueden pagar los medicamentos que necesitan ahora. Hemos tenido gente que muere por tratar de racionar su propia insulina. Tenemos pacientes en nuestra comunidad y pacientes de medicamentos asequibles que renuncian a comprar sus medicamentos, a tomar la dosis recomendada, no toman el mejor medicamento que funciona de manera más eficaz para ellos debido al precio. En este momento, al bajar los precios, podemos mejorar la salud de las personas con los medicamentos que están disponibles, pero que no son asequibles. En segundo lugar, la Oficina de Presupuesto del Congreso, que no es partidista, no tiene un interés personal, analizó el impacto de esta nueva ley y concluyó que de 1,300 nuevos medicamentos anticipados en los próximos 30 años, esta ley podría reducir ese número en 15. Es una gota en el océano, especialmente porque la mayoría de los medicamentos nuevos no son en realidad avances terapéuticos, son medicamentos de imitación. Así que estamos hablando de un impacto insignificante o inexistente en la innovación y el desarrollo de nuevos fármacos. Y finalmente, los topes de inflación van a ayudar con esto. En este momento, las compañías farmacéuticas para cumplir con los objetivos de ganancias y generar bonificaciones ejecutivas, aumentan los precios de los medicamentos viejos y no invierten para desarrollar nuevos medicamentos innovadores que podrían tener un precio alto. No vamos a dejar que sigan haciendo eso. Entonces, si quieren ganar más dinero, tendrán que inventar nuevos medicamentos innovadores que tendrán y deberían tener un precio alto. Así que esta legislación en realidad estimulará la innovación y el desarrollo de nuevos medicamentos, y no al revés.

 

Bill Walsh: Muy bien. Muchas gracias por eso, David. Volvamos a nuestros oyentes. Ahora es el momento de abordar más de sus preguntas con Leigh Purvis y David Mitchell. Y como recordatorio, presionen *3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP o dejen su pregunta en la sección de comentarios en Facebook o YouTube. Jesse, ¿a quién tenemos ahora en la línea?

 

Jesse Salinas: Sí, vamos a traer a Diane de Georgia.

 

Bill Walsh: Hola, Diane, ¿cómo está? Bienvenida a nuestro programa. Continúe con su pregunta.

 

Diane: Hola. Bien. ¿Como están?

 

Bill Walsh: Muy bien. Adelante.

 

Diane: Mi pregunta es esta. Tengo un amigo que usa una insulina muy costosa y... actualmente no... Medicare realmente no la cubre en este momento. ¿Eso va a estar incluido en este nuevo copago de insulina? Eso... Eso comienza el próximo año, ¿es correcto?

 

Bill Walsh: Sí. Diane, ¿puede darme un poco más de detalles sobre el tipo particular de insulina del que está hablando?

 

Diane: No sé el nombre.

 

Bill Walsh: Está bien. Esta bien. Bueno, preguntémosle a Leigh Purvis. Sí, adelante. Preguntémosle a Leigh Purvis sobre la cobertura de la insulina y cuándo entrará en vigencia, Leigh.

 

Leigh Purvis: Claro. Bueno, esos límites de copago de insulina comenzarán a funcionar a partir del próximo año. Pero se aplicarán a la insulina que cubre el plan en particular, lo que realmente destaca la importancia de que durante la inscripción abierta, que es aproximadamente dentro de un mes, se asegure de analizar las opciones de su plan de la Parte D de Medicare y de que su insulina esté cubierta por el plan en el que se va a inscribir. Es increíblemente importante porque los planes cubren la insulina, pero no necesariamente cubren toda la insulina. Por lo tanto, debe uno asegurarse de que cualquier plan en el que se inscriba cubra esa insulina y luego obtendrá ese copago máximo de $35.

 

Bill Walsh: Está bien, muy bien. Muchas gracias, Leigh. Jesse, ¿a quién tenemos ahora?

 

Jesse Salinas: Esta es Glendia en Texas.

 

Bill Walsh: Hola. ¿Hola, qué tal?

 

Glendia: Buenos días.

 

Bill Walsh: Hola, bienvenida al programa. Adelante con su pregunta.

 

Glendia: Gracias. Mi pregunta es... Todo es muy interesante, pero ¿hay algún lugar donde pueda ir y revisar todo? Tengo diabetes.

 

Bill Walsh: De acuerdo.

 

Glendia: Y la mayoría de mis medicamentos son muy caros, pero no puedo retener todo lo que se ha dicho hoy. ¿Hay algún lugar al que pueda ir y leer?

 

Bill Walsh: Sí, claro que lo hay. Glendia, primero que nada, se está grabando el programa. Y en 24 horas a partir de ahora, mañana, podrá escuchar todo de nuevo. También puede visitar aarp.org y ver la cobertura más reciente de lo que está en la ley y lo que significa para los consumidores. En esa cobertura, hay docenas de artículos que tocan mucha información que nuestros dos expertos han proporcionado hoy. Y creo que también habrá una transcripción del programa. Un buen sitio para visitar es aarp.org\RX. Además, si eres socio de AARP, estate atenta al boletín de AARP de septiembre, que probablemente llegue a sus buzones en cualquier momento. Tiene una amplia cobertura de la nueva ley y lo que significa para los consumidores. Así que espero que eso ayude. No sé si Leigh o David quieren dar otros consejos. Vale, bueno, Jesse, sigamos con nuestra próxima llamada.

 

Jesse Salinas: Nuestra próxima llamada es Roger en Luisiana.

 

Bill Walsh: Hola, Roger, bienvenido a nuestro programa. Adelante con su pregunta.

 

Roger: Sí. ¿Puede escucharme?

 

Bill Walsh: Sí, claro. Adelante con su pregunta.

 

Roger: Sí, solo estaba... Mi pregunta es, sé que algunos de los medicamentos se negociarán el próximo año, pero también estoy desconcertado por el hecho de por qué deben pasar cuatro años para que cualquiera de los medicamentos que van a revisar estén disponibles para el público. Eso parece mucho tiempo, cuatro años. Especialmente para aquellos de nosotros que podemos tener entre 70 y 80 años. Y la otra cosa que yo solo...

 

Jesse Salinas: Lo perdimos. Mis disculpas.

 

Bill Walsh: Ah, lo siento. Lo siento, Roger. Pero vamos a preguntarle... Vamos a plantear su pregunta. Roger quiere saber, y quiero decir, esa es una buena pregunta. ¿Por qué se necesitan cuatro años para que algunas de estas disposiciones entren en vigor? Leigh, ¿puede abordar eso?

 

Leigh Purvis: Sí. Y me hacen esta pregunta mucho. Y lo aprecio plenamente como alguien que tiene numerosos familiares que definitivamente se beneficiarán de las disposiciones de esta legislación. Y creo que la respuesta corta es que esto, la magnitud de los cambios que están teniendo lugar, no se puede sobrestimar. Y solo lleva algo de tiempo implementarlo. Por ejemplo, si observa los planes de la Parte D de Medicare, ya están listos para el próximo año. La inscripción abierta comienza en aproximadamente un mes. Por lo tanto, existen limitaciones sobre la cantidad de cambios que se pueden realizar sin alterar realmente el mercado. También es muy importante tener en cuenta, por ejemplo, cuando se trata de negociación, este país nunca ha negociado a esa escala, estamos hablando de más de 60 millones de personas. Y van a empezar desde cero en algunos aspectos. Hemos escuchado de los administradores que necesitarán llenar como 100 puestos, solo que llevará algo de tiempo poner en marcha este proceso. Y también se necesita dar algo de tiempo para negociar con las compañías farmacéuticas. Entonces, hay algunas disposiciones que se están implementando antes, como las vacunas sin costo y las multas por los precios más altos y los topes de copago, pero entiendo la frustración. Y es increíblemente importante. Y es por eso que hemos estado tan comprometidos con este tema. Y realmente refleja el hecho de que este ha sido un cambio fundamental y estamos dejando en claro que ya no vamos a aceptar precios sobre la base de lo que soportará el mercado. Y ese es un gran cambio. Y eso lleva algo de tiempo. Entonces, si bien hay algunas disposiciones que tendrán lugar un poco antes, la realidad es que tomará algunos años lograr que despeguen. Pero algo que también me gusta recordarle a la gente es que la Parte D de Medicare, que hemos mencionado muchas veces, la ley que creó la Parte D de Medicare se promulgó en noviembre del 2003, pero no entró en vigencia hasta enero del 2006. Históricamente hablando, los cambios de esta magnitud toman algún tiempo, pero a menudo se pasan por alto una vez que los beneficios realmente comienzan a notarse. Así que paciencia, y se avecinan grandes cambios importantes.

 

Bill Walsh: Muy bien. Muchas gracias por eso, Leigh. Jesse, tomemos otra llamada.

 

Jesse Salinas: Nuestra próxima llamada es de Carrie en Massachusetts.

 

Bill Walsh: Hola, Carrie, bienvenida al programa. Hola, bienvenida al programa. Adelante con su pregunta.

 

Carrie: Tengo una pregunta sobre los audífonos recetados. ¿Medicare va a comenzar, según esta nueva Ley del Cuidado de Salud a Bajo Precio, a pagar parte de la receta para ellos? Y si no será así, ¿por qué es?

 

Bill Walsh: Bien, buena pregunta. Leigh, ¿puede responder? Sé que nuestra colega Megan O'Reilly dijo que AARP sigue luchando por audífonos de menor costo.

 

Leigh Purvis: Sí, eso fue parte de la discusión en los primeros días de esta legislación, pero desafortunadamente, no llegó al paquete final. Pero AARP está muy comprometida con el hecho de que esos audífonos de venta libre estarán disponibles próximamente, disculpen, en dos meses. Y esa es una forma en que habrá una mayor competencia, y comenzarán a ver algunos audífonos de menor costo en el mercado. Eso será para las personas que tienen una pérdida auditiva baja o moderada, y ese acceso mejorará enormemente al tener esos audífonos de venta libre disponibles para todos.

 

Bill Walsh: Déjeme continuar con eso, Leigh, ¿qué puede decir sobre la calidad de esos audífonos de venta libre? ¿Pueden los consumidores esperar que sean de tan alta calidad como por la que han estado pagando miles de dólares a lo largo de los años?

 

Leigh Purvis: No sabría decirle, porque la comercialización apenas está comenzando. Ciertamente anticipamos que las personas podrán acceder a audífonos que los ayuden. Siempre se puede acudir al proveedor de atención médica si uno siente que le preocupa lo que ha podido obtener, pero esperamos que para las personas que tienen una pérdida auditiva de baja a moderada, estos productos definitivamente brinden un beneficio.

 

Bill Walsh: Muy bien. Gracias por eso, Leigh. Jesse, tomemos otra pregunta de los oyentes.

 

Jesse Salinas: Nuestra próxima llamada es de Chuck en Virginia.

 

Bill Walsh: Hola, Chuck, bienvenido al programa. Continúe con su pregunta.

 

Chuck: Sí. Mi entendimiento y observación es que... Esto solo se aplica a aquellas personas que tienen la cobertura de la Parte D de alguna forma. Tengo Medicare, no creo que no pague nada por mis medicamentos. Creo que TRICARE es mi, ya sabe, secundario... No sé si eso cuenta como una Parte D. Así que no sé si esto realmente aborda algo... Excepto aquellos que tienen la suerte de tener cobertura de la Parte D.

 

Bill Walsh: Bueno, hagamos que Leigh Purvis aborde eso. Leigh habló sobre el alcance de la cobertura hoy y quién en Medicare reunía los requisitos. ¿Podría hablar de eso otra vez?

 

Leigh Purvis: Claro. Se podría decir que muchas de las disposiciones que se incluyen en esta ley son específicas de Medicare. Entonces, si alguien tiene un plan de la Parte D de Medicare, está en un plan de la Parte D o alguien que está en Medicare tradicional, y tiene un medicamento recetado que está cubierto por la Parte B de Medicare, se beneficiará de esto. Pero creo que el punto anterior de David fue muy bien entendido, y es que estas disposiciones tendrán implicaciones más amplias de lo que creo que parecen, cuando las miras de forma superficial. Volviendo a los reembolsos basados ​​en la inflación, la métrica de precio que se utiliza para evaluar si es necesario pagar una sanción se basa en un precio que es ampliamente aplicable. En la medida en que esos precios negociados estén disponibles públicamente, puede suceder de ver a otras aseguradoras decir oye, también queremos esos precios. Y también esperamos que muchas de las ideas que son muy populares en esta ley, cosas como los topes de copago de insulina o la creación de esos límites de desembolso personal, probablemente se filtrarán a otras partes del sistema de atención médica. Entonces, aunque estas disposiciones pueden ser específicas de Medicare, la realidad es que van a tener implicaciones de mayor alcance y, con suerte, brindarán beneficios a muchas más personas.

 

Bill Walsh: Y, Leigh, déjeme seguir. Chuck había mencionado TRICARE. ¿Afectaría esto a las personas que dependen de TRICARE como su seguro médico?

 

Leigh Purvis: Nuevamente, en la medida en que TRICARE decida construir sobre las disposiciones o replicar las disposiciones que están en la ley, se podrían llegar a ver algunos beneficios. Una vez más, estas son ideas muy populares. Y creo que muchas aseguradoras van a prestar atención a lo que sucede con Medicare y potencialmente intentarán encontrar formas de hacerlo por sí mismas.

 

Bill Walsh: Está bien. Bueno, gracias, Leigh, y gracias también a David Mitchell. Esta ha sido una discusión muy informativa. También quiero agradecerles a ustedes, a nuestros socios de AARP, voluntarios y oyentes, por participar en la discusión de hoy. AARP, una organización de membresía no partidista y sin fines de lucro, ha estado trabajando para promover la salud y el bienestar de los adultos mayores durante más de 60 años. Todos los recursos de referencia de hoy, incluida una grabación del evento de preguntas y respuestas, se podrán encontrar en aarp.org/elcoronavirus el 8 de septiembre, mañana. Vayan allí si su pregunta no fue respondida y encontrarán las últimas actualizaciones, así como información creada específicamente para adultos mayores y cuidadores familiares. Además, vuelvan a participar el 15 de septiembre en un evento de preguntas y respuestas en vivo sobre el coronavirus, y también el 22 de septiembre en un evento especial de preguntas y respuestas en vivo con la experta en finanzas personales Suze Orman, quien se unirá a la directora ejecutiva de AARP, Jo Ann Jenkins, para abordar la inflación y cómo administrar el dinero y recortar costo. Gracias por acompañarnos hoy y que tengan un buen día. Esto concluye nuestra llamada.