House and Senate Leaders Reach Agreement on Legislation to Lower Drug Costs

Legislators worked throughout last weekend and announced provisions to lower drug prices and, for the first time, allow Medicare to negotiate with pharmaceutical corporations. Medicare price negotiation would be added to H.R. 5376, President Biden’s $1.85 trillion Build Back Better Act, which could begin to lower prescription drug prices for retirees and all Americans, an Alliance priority for more than 20 years.

The legislation also caps the price of insulin at $35 per month for all Americans and caps annual out-of-pocket drug spending by Medicare beneficiaries at $2,000. In addition, inflationary caps would limit drug corporations' capacity to raise prices faster than inflation.

Medicare would also cover all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) such as for shingles, which would be covered at no cost.

“Together these provisions would help millions of Americans afford the medicines that they need to stay healthy,” said Richard Fiesta, Executive Director of the Alliance.

“While there is more to do to rein in pharmaceutical corporations and allow Medicare to negotiate lower prices for additional prescription drugs in the future, President Biden, Speaker Nancy Pelosi and the House leadership deserve our thanks and recognition for the tremendous effort it took to include lowering drug prices in the legislation.”

Click here for a complete guide to how H.R. 5376 would lower prescription drug prices.

Build Back Better Act Will Also Fund Home Care, Adds Guaranteed Hearing Benefit to Medicare

Prescription drugs are not the only part of the Build Back Better Act that would change retirees' lives for the better.

The legislation includes $150 billion to expand home health care and services for seniors and people with disabilities while also increasing wages and benefits for caregiving workers. With this funding, hundreds of thousands more Americans would be able to receive the long-term care and services they need at home, rather than an institution.

“We also strongly support the expansion of Medicare to include guaranteed hearing benefits for seniors with hearing loss,” said Fiesta.

The average Medicare beneficiary spends $1,100 for hearing treatment, including hearing aids. Untreated hearing loss can lead to social isolation and falls and can increase the risk of dementia as people age. For more on the bill’s hearing benefits, click here.

Those provisions are all in addition to the bipartisan infrastructure bill, which was also on the verge of a House vote Friday, that includes $39 billion for quality public transit -- another important provision for seniors -- and $65 billion to bring broadband to every American, including 22 million seniors who lack internet access at home.

“The 4.4 million members of the Alliance urge the House and Senate to pass this legislation without delay,” Fiesta added.

Lower Premiums, More Choices for Affordable Care Act Patients in 2022

The Affordable Care Act’s (ACA) open enrollment period for health care coverage began this week on Monday, November 1 and runs through January 15, 2022. Consumers who are shopping for plans on the federal ACA health exchanges will find lower premiums and more choices for 2022. To choose a plan, go to https://www.healthcare.gov/glossary/open-enrollment-period.

Americans have shown increased interest in the exchanges due to the coronavirus pandemic. An additional 2.8 million people signed up for coverage on the federal and state marketplaces during a 6-month special enrollment period that the Biden Administration launched in mid-February, meaning that a record 12.2 million Americans were enrolled in Affordable Care Act policies as of mid-September. Three states -- Kentucky, Maine and New Mexico -- have launched their own exchanges for 2022.

“Prices for health insurance plans on the exchanges have dropped every year since 2018,” said Joseph Peters, Jr., Secretary-Treasurer of the Alliance. “Insurers have improved their ability to price their policies based on enrollees' needs, and the marketplaces have become more competitive.”

KHN: Nursing Home Residents Overlooked in Scramble for Covid Antibody Treatments

By JoNel Aleccia

Of the dozens of patients Dr. Jim Yates has treated for covid-19 at his long-term care center in rural Alabama, this one made him especially nervous.

The 60-year-old man, who had been fully vaccinated, was diagnosed with a breakthrough infection in late September. Almost immediately, he required supplemental oxygen, and lung exams showed ominous signs of worsening disease. Yates, who is medical director of Jacksonville Health and Rehabilitation, a skilled nursing facility 75 miles northeast of Birmingham, knew his patient needed more powerful interventions — and fast.

At the first sign of the man’s symptoms, Yates had placed an order with the Alabama Department of Public Health for monoclonal antibodies, the lab-made proteins that mimic the body’s ability to fight the virus.

But six days passed before the vials arrived, nearly missing the window in which the therapy works best to prevent hospitalization and death.

“We’ve been pushing the limits because of the time frame you have to go through,” Yates said. “Fortunately, once we got it, he responded.”

Across the country, medical directors of skilled nursing and long-term care sites say they’ve been scrambling to obtain doses of the potent antibody therapies following a change in federal policy that critics say limits supplies for the vulnerable population of frail and elder residents who remain at highest risk of covid infection even after vaccination.