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Consumerism

PHARMA's likely present to you... Price hikes

By from net, Posted in Consumerism

Big Pharma navigates new price limits. Once the calendar flips to January, consumers will begin to learn more about new pricing for their prescription drugs.

Pharmaceutical companies typically roll out price increases for hundreds of drugs in the first few weeks of the year. But new constraints on drug prices could limit increases.

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The federal climate and health bill, called the Inflation Reduction Act, restricts how much companies can hike Medicare drug prices for older adults. If drug companies increase prices above the rate of inflation, they must pay Medicare a rebate.

Those inflation penalties have already lowered prices on some drugs administered at hospitals, clinics and doctors' offices. In December, Medicare officials released a preliminary list of 48 drugs including blood thinners, antibiotics and chemotherapy medicines that could be subject to an inflation penalty in January. If those penalties were levied, Medicare would recoup money from drug companies and enrollees would likely pay lower cost-sharing for these drugs.

The federal law will also find new ways to pressure drug companies' prices. For the first time, the federal government has empowered Medicare to negotiate lower drug prices.

The Biden administration named the first 10 drugs the federal government plans to negotiate but the price changes on those diabetes, heart disease and cancer drugs won't take effect until 2026. Over the next two years, another 30 drugs will be selected for negotiated prices beginning in 2027 and 2028.

Drug companies and their industry allies have challenged the process, filing several lawsuits aimed at halting price negotiations.

While consumers won't see discounts from negotiated prices until 2026, other provisions promise more immediate savings. For example, in 2025, enrollees in Medicare's Part D drug plans will have their out-of-pocket expenses for prescriptions capped at $2,000 per year.

Other factors could influence prices in 2024, as Congress continues to scrutinize the role drug pricing middlemen, called pharmacy benefit managers, play in the prescription drug market.

The U.S. House of Representatives passed health care price transparency legislation that would ban pharmacy benefit managers from Medicaid spread pricing. This form of pricing occurs when pharmacy middlemen charge more than what they pay pharmacies for prescriptions. Senate committees also are working on legislation to bolster oversight of pharmacy benefit manager practices.

As the Inflation Reduction Act limits annual price increases for seniors and political pressure builds on drug-pricing middlemen, some analysts say pharmaceutical companies might try to launch new drugs at ever-higher prices. This could include Eli Lilly's donanemab, a drug that slowed cognitive decline in people in the early stages of Alzheimer's disease. The FDA will review the drug by the end of March and it could hit the market shortly after.

Supreme Court mifepristone case, abortion access on the ballot
The fate of a drug used to terminate pregnancies is now before the U.S. Supreme Court in two new cases, bringing a renewed focus to abortion access in the wake of the Dobbs ruling that overturned Roe v. Wade.

In December, the Supreme Court agreed to hear cases that rolled back access to mifepristone, an oral drug that is used jointly with another drug, misoprostol, to end a pregnancy in the first trimester. Medication abortions are the most common form of abortion in the U.S.

The Food and Drug Administration approved mifepristone, which patients across the U.S. can access through telemedicine and the U.S. mail. In 2016, the FDA determined that only one doctor's visit, instead of three, is necessary for a patient to be prescribed mifepristone.

The high court's ruling, expected by late June, could significantly hinder access to abortions through telemedicine and the mail, especially for people in rural areas and those who have limited ability to travel to an abortion clinic. The ruling also has implications for people seeking abortion in states where it is legal.

The 2024 ruling could restrict access beyond the Supreme Court's 2022 decision to overturn Roe v. Wade, the 1973 case that affirmed a constitutional right to abortion. The Dobbs ruling in 2022 resulted in several Republican-controlled states effectively cutting off abortion.

Voters this year began weighing in on new measures that would limit or expand access. In November, abortion rights activists scored key victories in Ohio, a Republican-leaning state where voters enshrined abortion access in the state constitution, and in deep-red Kentucky, where Democratic Gov. Andy Beshear won reelection championing abortion rights.

In Texas, Kate Cox, a Dallas-area mother of two, challenged her state's strict anti-abortion laws in December after she learned that her fetus at 20 weeks had a deadly genetic condition. The Texas Supreme Court prohibited her from terminating her pregnancy based on state laws that restrict doctors' rights to perform abortions. Cox opted to travel outside of Texas to end the pregnancy.

Doctors who provide abortions under these circumstances can be sentenced to life in prison under state law. Private citizens can also sue any person who helps another person someone obtain an abortion. Restrictions like these have resulted in a brain drain of doctors leaving or skipping out on jobs in Texas and other states because of the limits on medical practice.

The 2024 presidential election is likely to touch on abortion access, and it's likely candidates will cite Cox's case and others as they talk about the country's future.

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