Prescription Drug Pricing – Better for Seniors

Every time I see a commercial for a new drug, with happy, carefree Americans living their best lives, or even singing in the street, I get ill. Four years ago, my husband and I were caregivers for a man who was taking 10 medications a day. He had damned good insurance. I know this because I picked up the medicines and never spent more than $100. I personally “only” take 4. All generic. And yet, when there was a mix-up about dates and I was about to run out, I had to pay out of pocket. Two pills. $120. It really made me stop and think – what might happen to me if I lose my job before I reach 65? Will Medicare give me a good price on the drugs I need to function? Will a doctor help me choose a new regimen that can get me down to one prescription if I can’t afford 4? And will it be generic? I know there are millions of Americans with such questions. I also remember being in a pharmacy with a woman who had been kicked off of Medicaid. She needed 8 medicines. When she was on Medicaid, the prices for each medicine were around $3. With her new insurance, the price went up to $15. For 8 medicines. She didn’t have the money and was frantic. I could still hear her crying as I left.

When Biden put together the plan to lower drug prices, it was *only* for Medicare patients – a mere 17% of the American population. The implications sickened me. Drug companies would still be able to charge full price to everyone else. If health insurance had to eat most of it, the costs would rise. If someone had no insurance, or inadequate coverage, they might have to try to survive by skipping doses or making do. If they knew how, they might be able to get their drugs from Canada, Mexico or overseas. If they had a GoodRx card, they might get a discount. But for everyday people, the pharmaceutical system is stacked against them.

Insulin was the first targeted drug. At the start of 2023, for 4 million seniors on Medicare, the cost for a month’s supply was capped at $35 thanks to Biden’s Inflation Reduction Act. What was it previously? Anywhere from $67 – $270, depending on the brand. Diabetes is virtually an epidemic with seniors: 29% of all seniors, nearly 1 in 3, are diabetic, possibly without knowing it. So, passing the bill to cap insulin costs for seniors was a big deal. When drug maker Eli Lilly capped the price at $35 for *everyone*, followed by drug makers Novo Nordisk and Sanofi, who together produce 90% of all insulin in the country, they changed countless lives as many diabetics had been rationing their supply to make it stretch… and some died.

Biden’s next attempt to regulate drug prices has also passed, but the dates are so far out that a change in the administration could put the effort in jeopardy. Instead of capping prices, Medicare will be able to “negotiate” the price. A win for the pharmaceutical giants, and probably the only way the bill got through Congress. There are 10 drugs on the list of medicines for which prices will be negotiated for Medicare patients over the next 12 months, with prices dropping in 2026. I took a look at the list when it came out, and I was quite disgusted to see that I’d heard of many of the drugs. Not because *I* needed them, but because the pharmaceutical companies were constantly running ads about them. Expensive ads. For expensive drugs. Eliquis to lower risk of stroke ($600/month), Jardiance which treats Type 2 diabetes ($570/month), Stelara the wonder drug that treats everything from plaque psoriasis to forms of arthritis to colon issues ($13,000/injection). Almost all of the other drugs on the list are related to diabetes, blood and heart issues. Issues key to the lives of seniors.

I’m hoping at some point, that our government will go further. On the list of things pharmaceutical that pisses me off is the price of an EpiPen – the lifesaving epinephrine injector for people who have unexpected allergic reactions. One in 50 Americans has a life-threatening allergy and many have an EpiPen on hand for anaphylactic shock. Yet, an EpiPen for someone who is uninsured can cost up to $750. (Walmart has gotten the price down to $350.) Moreover, EpiPens are only good for 12-18 months, although I am sure that people who can’t afford to keep buying them are hoping that they will work for longer. Mylan, the company that makes the EpiPen, has managed to avoid any major competition for over 35 years, because they constantly make small changes which enable them to maintain patent rights. There are probably other ridiculously expensive drugs out there for a small niche of patients who need them to survive. Like Biktarvy for HIV patients – $4000 /month– with a beautiful ad of a gay couple walking down the beach.

It has been at least 6 years since Bernie Sanders touted Medicare for All during his 2016 presidential campaign. As a senator, Sanders has advanced a Medicare for All bill every year since 2017. Medicare for All is a single payer system where health costs are subsidized by the government like our current Medicare system, but instead of private insurance companies, it’s paid for by increased income taxes. A single-payer Medicare for All would be a major blessing for Gen X’ers who have had to leave the workforce for medical issues. It would help the Millennials who are kicked off of their parents plan at 26 and are struggling with asthma, clinical depression and other health issues. I would love to see Medicare for All in my lifetime. But we would need a drastically different Congress. If our government could do something to rein in drug prices for the uninsured, that would be a start.