An increasing number of older Americans can’t afford the prescriptions they need to stay healthy. In a recent study, roughly 1 in 5 people age 65+ took shortcuts—such as skipping doses or delaying refills—due to financial worries.1 Said President Biden in a statement: “For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear.”
That could soon change as a result of the Medicare Drug Price Negotiation Program. If you have Medicare, keep reading to find out how (and when) this program may affect you or an older adult you care for.
What is the Medicare Drug Price Negotiation Program?
The Medicare Drug Price Negotiation Program is part of the Inflation Reduction Act (IRA) of 2022, which includes several provisions to help lower prescription drug costs for people with Medicare. This provision will allow Medicare—for the first time ever—to negotiate drug prices directly with pharmaceutical companies. The goal is to improve the affordability of some of the most expensive drugs covered under Medicare Part B and Part D. Part B covers drugs administered by a physician.
Reduced prices from drug negotiations for the first 10 drugs will take effect starting in January 2026.
Going forward, the Centers for Medicare & Medicaid Services (CMS) will then select:
· Up to 15 additional drugs to negotiate for 2027
· Up to 15 additional drugs (including those under Part B) for 2028
· Up to 20 additional drugs for 2029 and subsequent years
“Today’s announcement is a game changer for the millions of older adults who rely on these medications every day," said Ramsey Alwin, NCOA President and CEO, in a statement on the start of drug price negotiations. "Our research shows that the cost of chronic conditions falls heaviest on women and people of color, who have the fewest resources. Lower prices are a matter of equity."
A recent KFF survey showed strong bipartisan support (83%) for allowing the federal government to negotiate drug prices.
Which prescription drugs will be negotiated?
The drugs that qualify for Medicare price negotiation are from a list of high-cost, brand-name, single-source drugs that have no generic competition on the market. In 2022, Medicare enrollees paid a total of $3.4 billion in out-of-pocket costs for these medications.
The 10 drugs selected for the first round of Medicare negotiation:
· Eliquis: For preventing strokes and blood clots
· Jardiance: For type 2 diabetes and heart failure
· Xarelto: For preventing strokes and blood clots
· Januvia: For type 2 diabetes
· Farxiga: For chronic kidney disease
· Entresto: For heart failure
· Enbrel: For arthritis and other autoimmune conditions
· Imbruvica: For blood cancers
· Stelara: For Crohn’s disease
· Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill: Insulin products for diabetes
How will these changes affect me?
Once fully implemented, the Medicare Drug Price Negotiation Program is expected to drop prices on negotiated drugs for up to 9 million older adults, who now pay as much as $6,497 out of pocket each year for these medications. People with Medicare will have better access to prescription drugs that help them manage chronic and life-threatening conditions. More older adults will be able to start medications, take them appropriately, and stay on them without making potentially dangerous trade-offs.
Experts predict the program will also save taxpayers $160 billion by lowering Medicare costs.
Other Medicare prescription drug provisions
In addition to drug price negotiation, there are several other important provisions in the Inflation Reduction Act designed to lower healthcare costs for people with Medicare.
Several provisions have already taken effect:
· Medicare will cover a greater portion of the cost for high-quality biosimilars (drugs made from a natural source) for a period of five years, which began October 1, 2022.
· Monthly out-of-pocket cost sharing for insulin is capped at $35.
· Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are 100% free.
· Drug manufacturers that raise their prices at a faster rate than inflation will face a financial penalty.
Starting in 2024:
· The 5% coinsurance for catastrophic drug costs will be eliminated.
· Eligibility for the full Medicare Part D Low-Income Subsidy (LIS, also called “Extra Help”) will be expanded to beneficiaries with incomes up to 150% of the federal poverty level. LIS lowers premiums and out-of-pocket costs for prescription drug coverage.
· From 2024-2029, annual Part D premium increases will be capped at 6%.
Starting in 2025:
· There will be a $2,000 annual cap on drug out-of-pocket costs. This could save beneficiaries $400 each year on prescription drug costs. Enrollees with the highest out-of-pocket drug costs could save $2,500 per year. In addition, the Medicare Prescription Payment Plan provision will allow enrollees to pay their out-of-pocket prescription costs in the form of fixed monthly payments over the course of the plan year (instead of all at once).
“These key provisions will help promote equitable aging by making vital medications affordable for more older Americans,” says Josh Hodges, NCOA’s Chief Customer Officer. “Reducing drug costs will serve to improve the Medicare program now and ensure it remains strong and solvent for future enrollees.”
The Inflation Reduction Act also extends premium subsidies for the Affordable Care Act (ACA) Marketplace into 2025. As a result, an estimated 10 million people will save about $700 annually on their healthcare premiums.
1. Stacie B. Dusetzina, PhD et al. JAMA Network. Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022. May 18, 2023. Found on the internet at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805012
This article was written by the National Council on Aging, September 14, 2023.
Pharmaceutical companies Pfizer and GlaxoSmithKline (GSK) have each developed a vaccine to protect older adults from a virus known as RSV. People over 60 are at significant risk of serious complications if they contract RSV. Fortunately, with the recent FDA approval of Pfizers Abrysvo vaccine and GSKs Arexvy vaccine, along with practical safety measures, seniors can take steps to avoid the effects of this virus.What Is RSV?Respiratory Syncytial Virus (RSV) is a respiratory infection that mimics the common cold. Most people recover from RSV within two weeks after initial exposure to the virus. However, the virus can cause serious complications in older adults.Symptoms of RSV can include:CoughingFeverSneezingRunny noseDecreased appetiteWheezingNew RSV Vaccines Are on the HorizonGSK has developed an RSV vaccine that has recently received Food and Drug Administration (FDA) approval. It developed the vaccine Arexvy to prevent lower respiratory disease in older adults caused by RSV. Arexvy is the first RSV vaccine approved for use in the United States.The GlaxoSmithKline approval was based on positive data that included a showing of an overall vaccine efficacy of nearly 83 percent in older adults with at least one underlying medical condition.Before submitting its vaccine for FDA approval, Pfizer also conducted tests to determine its efficacy. The main clinical study found that Abrysvo had an efficacy of almost 86 percent in participants. The study also found that the vaccine significantly reduced the risks of adults older than 60 developing RSV-associated lower respiratory tract disease by about 83 percent.Some participants reported side effects that included injection site pain, joint stiffness, muscle pain, headaches, and fatigue. A small number of participants in the Arexvy studies developed Guillain-Barre Syndrome and acute disseminated encephalomyelitis (ADEM). The FDA is requiring GSK to complete a subsequent study to determine whether there is a significant risk that users will develop Guillain-Barre Syndrome or ADEM.RSV is a seasonal disease, with a season typically beginning in the fall and peaking in the winter. GlaxoSmithKline reports that the Arexvy vaccine is effective across two RSV seasons.Who Is at Risk for RSV?Older people are more vulnerable to contracting RSV. As we age, our immune systems naturally weaken, and we become more susceptible to disease, including RSV. Seniors at the greatest risk of getting RSV are those with chronic heart or lung disease. According to the Centers for Disease Control and Prevention (CDC), 60,000 to 160,000 older adults are hospitalized and between 6,000 and 10,000 seniors die each year from RSV nationwide.Potential Complications for Older Adults With RSVRSV can lead to serious complications in people aged 60 and over, including severe infections that can lead to extended hospital stays.RSV is an illness that affects the respiratory system, so seniors with the following underlying illnesses may experience significant problems fighting off the RSV infection:Chronic Obstructive Pulmonary Disease (COPD)Congestive heart failureAsthmaExacerbation of pneumoniaSeniors Can Adopt These Practices to Help Stop the Spread of RSVRSV is an easily transmittable disease. Fortunately, seniors can adopt simple habits to contain the spread. Some of the following practices can save your life or the life of your loved ones:Stay Away From Public Places When Youre SickIt is critical to avoid public places like grocery stores, recreation centers, nursing home common areas, and the like when you are sick. RSV is highly contagious, so if you are ill, stay away from others to avoid spreading the disease. Clean and Disinfect Frequently Touched SurfacesClean and disinfect high-traffic areas. Be sure to wipe doorknobs, countertops, and other areas that are typically frequented in your home. Avoid Close Contact With Sick PeopleYou should avoid anyone that is sick. Again, RSV is highly communicable, and an older adult may face serious consequences if they are infected. Dont Touch Your FaceNever touch your face with unwashed hands. Avoid touching your eyes, nose, or mouth with unwashed hands. Wash Your HandsWash your hands with soap and water frequently and for at least 20 seconds. If soap and water are unavailable, consider using an alcohol-based hand sanitizer.Both vaccines are expected to become available in the United States in the fall of 2023.Contact Sharek Law Office at 412-347-1731 or click here to schedule a complimentary 15-Minute Call to see how we can help. This article is a service of Sharek Law Office, LLC. We dont just draft documents; we ensure you make informed and empowered decisions about life and death, for yourself and the people you love. That's why we offer a Life and Legacy Planning Session, during which you will get more financially organized than youve ever been before, and make all the best choices for the people you love. You can begin by calling our office today to schedule a Life and Legacy Planning Session and mention this article to find out how to get this $750 session at no charge. Please note this is educational content only and is not intended to act as legal advice.
Forgetting pills happens to the best of us. While it may not be a huge deal occasionally, inconsistent medication adherence can be a significant problem for adults who take life-saving and quality-of-life medications. Sticking to a regular medication schedule reduces your risk of disease or complications. Theres an old saying in the medical world that medications dont work for patients who dont take them.There are lots of factors that impact medication adherence like high costs of medicines, inability to retrieve prescriptions, not having access to pills, and medication management. But the biggest reason is often the most obvious one: we simply forget to take our pills. With revolving schedules and tons of pills, it can be hard to remember to take one pill when you wake up, another with breakfast, another on an empty stomach, another when the sun is shining due south, and one before bed but after youve brushed your teeth. For those of us with complicated pill schedules, medication adherence can be a burden. Medication adherence is critical. Your doctor put you on your medicine for a reasonwhether its to control a disease, manage symptoms, or improve your quality of life. Its important to take your pills in the way theyre meant to be taken. Here are 13 of GoGoGrandparents go-to tips to help adults remember their pills and make medication adherence as natural and habitual as brushing your teeth. Use a clear, weekly pillbox. Pillboxes have compartments for each day and dosing time. A clear pillbox is a great visual reminder to see if you have already taken your pills for the day. A pillbox is also the simplest way to prevent double doses and missed doses. Plus, it makes life easier if you have a lot of medications because you can prep your pills in advance. Keep your pills visible. If theyre out of sight, then theyre out of mind, so make sure you put your pills somewhere youll see them. This might be the bathroom counter or bedroom nightstand for evening pills or in front of the coffee machine or toaster for morning pills.While you want your pills to be in a visible spot, you also should make sure they are in a safe place. Keep your pills away from direct sunlight, heat, and moisture to keep your pills from spoiling. Also, make sure your pillbox is safely secured from any children or pets. Pair taking pills with a habit you already have. For example, if you need to take a certain pill with food, make a habit of taking the pill before your first bite at each mealtime. Or take your morning pills with your first sip of coffee. Attaching taking your pills to habits you already have will make medication adherence much easier. Set an alarm on your cell phone or watch to alert you when its time to take your medications. Dont stop the alarm until youve taken the medicine. Snooze the alarm if you must so it doesnt slip your mind. Keep a calendar or medication journal. This will let you keep track of all the medicines and doses. List all of your medications including medication name, reason for taking, dose, frequency, time of day, and special instructions. For some people, a smartphone app is a convenient option. You might want to use this to keep track of when youve taken each pill. This is also a great list to have on hand when you visit the doctor. Use a dry-erase board to keep track of your medication compliance schedule. A dry-erase board works like a medication adherence calendar, but some people prefer a dry-erase board as a visual reminder. At the beginning of the week, write on the board all of your doses for the week and then erase each dose after youve taken it. Place reminder sticky notes around the house to help remember to be adherent to medication. Place these on the fridge, bathroom mirror, or anywhere that will help you remember to take your pills. Ask your healthcare provider to help come up with a medication adherence and administration plan. Your doctor will be able to create the most optimized treatment options, like simplifying medications or changing your frequency of doses. Ask your pharmacist if they offer reminder tops for your pills. These are pill bottles with caps that have reminder alarms for your medications. If your pharmacy doesnt offer these, you can buy some on Amazon as well and put them on top of your prescription bottles. Put refill reminders on your calendar. Not having any missed days is an important part of medication compliance. Making sure you have all of your prescriptions is critical to staying consistent. (Also, using a pillbox may help alert you in advance if you are running low on a certain prescription.) Keep extra medicine in your bag or purse in case you get tied up away from home. You may also want to give extra medication to caregivers or family members, so they have some on hand just in case. The number one tip for medication adherence is to always make sure you always have your prescriptions on hand. The easiest, hassle-free way to get your prescriptions is through GoGoGrandparents prescription delivery service. GoGo offers prescription delivery for seniors and people with disabilities, so you can have your medications delivered right to your door. GoGo offers pickups from Costco, Walmart, CVS, your local pharmacy, and more so you can have prescriptions delivered from multiple locations. You can even set up automatic pickups, so a GoGo driver will deliver your prescriptions on a regular schedule.Behind the scenes, GoGoGuardians monitor your prescription requests, track your delivery, and help make sure youre getting your medications on time. Thats what makes us different. We dont just deliver pills; we become a part of your care team to help you stay adherent to medication schedules. All you have to do is call 1 (855) 464-6872 and press option 6 to be connected to the GoGo prescription team, and well let you know when a driver is on their way!
How does GoGos prescription delivery service work? Missing even one dose of medication can cause serious and in some cases, life-threatening effects. Thats why its so important to have your prescriptions on hand and ready when you need them. But what if you cant get to the pharmacy when your prescription is filled? Thats where on-demand pharmacy delivery comes in. With GoGos prescription delivery service, you can have your medicine delivered quickly and easily from the comfort of your home. GoGoGrandparent offers pharmacy delivery, so you can get your prescription medication delivered from your local pharmacy right to your door. Learn more about GoGos prescription delivery service here. Heres what you do:Call your local pharmacy to make sure your prescription is ready. Let the pharmacist know that someone will be picking up your order on your behalf. We also recommend you put your insurance information and credit card on file with your pharmacist directly. For your safety, we do not recommend giving payment to your driver. Call GoGoGrandparent toll-free at 1 (855) 464-6872 and press 6 to be connected to our pharmacy delivery team. Tell them youd like medicine delivered from your local pharmacy. Thats it! Our team will take it from there: Well find a local driver who can deliver medication.Well give them your first name, last name, phone number, birthday, and home address. They give this information to the pharmacist. Dont worry, our GoGoGuardians screen and vet all our drivers, so your personal information is protected. Behind the scenes, our GoGoGuardians are monitoring your request and tracking your pharmacy delivery. Well ensure your driver picks up the right medication, locates your home, and drops off your prescription delivery in a location thats convenient for you. Youll likely get your prescription delivery within a few hours. The time it takes to deliver medication will depend on driver availability, distance, and the pharmacys busyness. Benefits of GoGo prescription delivery Why do hundreds of thousands of people choose GoGo from prescription delivery services? You can have your prescriptions delivered from any pharmacy. Whether you use a local pharmacy, a chain, or even Costco, our drivers can deliver medication filled at any reputable pharmacist. Some large chains like CVS may offer in-house prescription delivery for certain medications. However, these might take hours or days to get to you depending on their carriers. GoGoGrandparent can get your medicine delivered in just a few hours, so you can always adhere to your medication schedule. You dont have to deal with driving to the pharmacy, battling crowds, or waiting in line. You can have your medicine delivered while youre cooking breakfast, watching your favorite television program, or taking a quick cat nap. You can even schedule prescription delivery in advance. If you refill your prescription every six months, every month, or even every week, GoGo Prescription Delivery can help track your pharmacy delivery frequency so you always stay on track with your medicine. Our Family Features allow your loved ones to monitor your prescription delivery service as well. Your family members and caregivers can use GoGos family dashboard to schedule and pay for pharmacy deliveries, as well as monitor your other GoGo services like Rides, grocery delivery, meal takeout, and home services. Dont miss a pill, and dont let your prescriptions sit around waiting for you at the pharmacy. Having your medicine delivered to your door means you can stick to your medication schedule while freeing up your time to do more of the things you love. Want to try out GoGos prescription delivery service for yourself and see how easy it is to use? Register for GoGoGrandparent right now. It takes only a few minutes to create an account, then you can start scheduling your prescription delivery!