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Legislation Still Falls Short for Patients

Medicare patients with chronic disease remain in desperate need of real cost relief

August 09, 2022 08:50 AM Eastern Daylight Time

WASHINGTON - The Partnership to Fight Chronic Disease (PFCD) released the following statement today in response to the Senate’s passage of the Inflation Reduction Act of 2022:
“PFCD has long stood for comprehensive and sustainable solutions that protect both overall health outcomes and pocketbooks of people living with one or more chronic conditions. While this legislation is a solid step in a better direction for those who rely on insulin and reach the new catastrophic threshold of $2,000, there still is significant work to be done to support the millions of other Americans living with chronic conditions. The legislation does nothing to address the pervasive access barriers insurers and pharmacy benefit managers (PBMs) place on patients, including high out-of-pocket costs, step therapy, and prior authorization hurdles. Failing to implement copay caps for a broader array of Medicare beneficiaries suffering from chronic diseases is a missed opportunity to make prescription drugs affordable for those managing multiple conditions.
“Adding to this shortfall for patients is the absence of any measures to curb access restrictions for seniors with chronic illness. Seven in ten Medicare beneficiaries have at least two chronic conditions and four in ten have four or more. To address affordability, it is essential to more directly address rising costs at the pharmacy counter and pass along those savings directly to the people relying on medicines for their health. Smoothing costs over the plan year and a cap on maximum out-of-pocket costs are positives in the bill, but unlike previous versions, the Senate’s bill delays implementation of these important reforms for years and provides no immediate relief for the seniors who need it now.
“Another major concern with the legislation is that it leaves older Americans, people living with disabilities, and people with chronic conditions at serious risk of discrimination. The bill fails to enact protections against the use of the quality-adjusted life year (QALY) as a part of the troubling price setting practices touted as an achievement of the proposal. Other nations use the QALY in price setting for medicines and other coverage decisions that have led to serious access restrictions and coverage denials. The National Council on Disabilities has raised these issues repeatedly and shared recommendations with Congress. More than 130 patient, provider, and disability rights organizations, including PFCD, wrote to Congress urging to specifically reject the use of QALYs in federal programs. The legislation fails to include these critical protections.”
For more on the myriad issues facing America’s increasing chronic disease population and opportunities for meaningful reform, please visit: