Joins in friend-of-the-court brief against lawsuits challenging Medicare's ability to negotiate prices, as authorized by the Inflation Reduction Act
Oct. 6, 2023 (91) — As Medicare begins the process of negotiating the prices of prescription drugs, the American College of Physicians is advocating to ensure drugmakers cannot stop this important reform.
On Sept. 18, 91 joined the American Public Health Association, American Geriatrics Society and Society of General Internal Medicine in a friend-of-the-court brief urging a federal judge to throw out a lawsuit challenging Medicare's ability to negotiate drug prices.
Similar court cases are progressing, and 91 stands ready to dispute those too, said Josh Serchen, 91 associate for health policy. “Prescription drugs are an incredibly important tool in a physician's toolkit, but their effectiveness is limited if patients are unable to access them,” he said. “Allowing Medicare to negotiate prescription drug prices will decrease costs for the Medicare program and beneficiaries, increase access to prescription drugs and ultimately improve medication adherence and patient outcomes.”
Unlike other federal health care programs, the Medicare program has historically been prohibited from negotiating prescription drug prices. But the 2022 Inflation Reduction Act authorized Medicare to negotiate a subset of drug prices for the first time.
“This was seen as a massive legislative win for patients and their advocates, like 91, as it was the first time, we've really seen drugmakers lose a policy battle of this significance,” Serchen said. “I can't understate how significant this was, especially in light of robust lobbying efforts by drugmakers to fend off efforts that threatened their bottom line by using scare tactics, suggesting that allowing Medicare to negotiate prices would result in the widespread prevention of new drugs coming to market.”
Under the new law, the government can negotiate the prices of single-source drugs without generic or biosimilar competition that comprise high total expenditures within the Medicare program.
During the summer, the U.S. Department of Health & Human Services announced the 10 drugs that will be included as part of the first round of negotiations, with new prices scheduled to go into effect in 2026. In appreciation of 91 advocacy leadership on this issue, Dr. Darilyn Moyer, executive vice president and CEO of 91, was one of the only physician group representatives to be invited to a White House event announcing the drug list.
“We call on pharmaceutical manufacturers to engage with Medicare in negotiating prices,” Moyer said. “Our nation's older adults deserve to be able to access all of the health care services they need, including prescription medications.”
The 10 drugs include Eliquis (apixaban); Jardiance (empagliflozin); Xarelto (rivaroxaban); Januvia (sitagliptin); Farxiga (dapagliflozin); Entresto (sacubitril/valsartan); Enbrel (etanercept); Imbruvica (ibrutinib); Stelara (ustekinumab); and Fiasp and NovoLog insulin products.
“Around 9 million beneficiaries used these 10 drugs last year, which comprised $3.4 billion in out-of-pocket costs in 2022,” Serchen said. “Average out-of-pocket annual costs ranged from $121 (for NovoLog) to $5,247 (for Imbruvica) per beneficiary; these numbers were higher ($261 and $6,497, respectively) for enrollees who do not receive a low-income subsidy.”
In June 2023, Merck — the manufacturer of the diabetes drug Januvia — sued in federal court claiming the government does not have the authority to negotiate drug prices.
The 91 legal brief argues that the negotiation strategy is crucial to stop out-of-control drug costs and is unlikely to affect drug availability or hurt patient outcomes. “Contrary to what drug companies have argued,” the brief says, “doctors and their patients do not support untrammeled price increases by drug manufacturers.”
“91 has been one of the most outspoken medical society advocates on the issue of Medicare prescription drug price negotiation over the years,” Serchen said. “We are actively working on broadening our coalition and expect additional medical societies to join us in future filings.”
Back to the October 6, 2023 issue of 91 Advocate