The 2022 Inflation Reduction Act included a historic provision allowing the government to negotiate with drug companies for the first time. 10 particularly expensive drugs were already negotiated, with reduced costs taking effect in 2026. Just in the first year, Medicare beneficiaries are projected to save $1.5 billion out-of-pocket. This is significant, but also highlights our international distinction of holding zero leverage with the pharmaceutical industry until recently. Even now, only the ~15% of Americans with Medicare Part D will be eligible for discounts (ie, the millions of seniors without Part D–and everyone with private health insurance–will continue to pay more for the same drugs).
This year, the new administration indicates it will comply with the second round of negotiations which includes 15 additional drugs. The sexiest is semaglutide, formulated as Ozempic, Rybelsus, and the higher-dose Wegovy. Thus far Medicare covers Wegovy for patients with obesity and comorbid heart disease, but not for weight loss alone. The pharmaceutical industry and various factions are diligently lobbying to change that. If Wegovy coverage is expanded for weight loss, millions more patients will become eligible and Medicare expenditures on Wegovy will dwarf the savings from its negotiated price.
Other drugs on the list of 15 include:
- Trelegy and Breo inhalers for chronic obstructive lung disease, a formidable and costly consequence of smoking in most cases
- Tradjenta and Janumet for type 2 diabetes
- Xtandi, Pomalyst, and Ibrance for various cancers associated with obesity
- Linzess and Xifaxan for irritable bowel syndrome (IBS is highly amenable to dietary intervention; Xifaxan is also prescribed for hepatic encephalopathy which follows excess alcohol use)
- and Otezla for psoriatic arthritis, which is again linked to obesity, drinking and smoking
The remaining 4 drugs target medical conditions less associated with lifestyle. Though 2 of them share a relationship: Austedo is typically prescribed to treat the distressing facial twitch that results from long-term use of antipsychotics like Vraylar.
Medicare’s drug negotiations are crucial, but only the tip of the price-berg. How much more could patients and tax-payers save if we reined in targeted advertising for bacon cheeseburgers and flavored vodka?
herbivores.life 