7 healthcare takeaways from Senate Democrats’ newly passed $739B landmark bill

7 healthcare takeaways from Senate Democrats’ newly passed $739B landmark bill

https://www.beckershospitalreview.com/finance/7-healthcare-takeaways-from-senate-democrats-newly-passed-739b-landmark-bill.html

With a 51-50 vote, Senate Democrats passed a sweeping $739 billion bill Aug. 7 that furthers some of the largest changes to healthcare in years.

Titled the Inflation Reduction Act, the bill touches energy, tax reform and healthcare. The House is expected to take it up Aug. 12, with Democrats aiming to approve it and send it to President Joe Biden’s desk.  

Here are seven healthcare takeaways from the 755-page bill

Drug pricing

1. For the first time, Medicare would be allowed to negotiate the price of prescription medicines with manufacturers. Negotiation powers will apply to the price of a limited number of drugs that incrementally increases over the next seven years. Ten drugs will be eligible for negotiations beginning in 2026; eligibility expands to 15 drugs in 2027 and 20 by 2029. 

2. The HHS secretary will provide manufacturers of selected drugs with a written initial offer that contains HHS’ proposal for the maximum fair price of the drug and reasoning used to calculate that offer. Manufacturers will have 30 days to either accept HHS’ offer or propose a counteroffer.  

3. Members of Medicare Part D prescription drug plan would see their out-of-pocket costs for prescription drugs capped at $2,000 per year, with the option to break that amount into monthly payments, beginning in 2025.

4. Democrats lost on a provision to place a $35 cap on insulin for Americans covered by private health plans. The provision to cap insulin at $35 dollars for Medicare enrollees passed by a of 57-43. 

5. Drug companies will be required to rebate back price differences to Medicare if they raise prices higher than the rate of inflation, coined an “inflation rebate.”

6. The legislation makes all vaccines covered under Medicare Part D free to beneficiaries with no deductibles, co-insurance or cost-sharing, starting in 2023. 

Tax subsidies 

7. The legislation extends the Affordable Care Act’s federal health insurance subsidies, now set to expire at the end of the year, through 2025. Democrats say the extension will prevent an estimated 3.4 million Americans from losing health coverage.

This can be a slippery slope to what Congress can control… Did they only mandate $35/month price limit ONLY ON INSULIN PAID FOR BY Medicare Part D and part  C, maybe because it would be a bad political move – and possibly unconstitutional – to tell private insurance companies and the three pharmas that produce insulin… in what they can charge for a product.

The PBM industry claims that they “negotiate” with pharmacies on what they will be paid to fill prescriptions and that industry controls about 90%+ of the FOUR BILLION Rxs that are filled in the USA.  Their action of  “negotiating ” with pharmacies is actually a “take it or leave it” contract. In the end the pharmacy is told to sign/take the contract offered or we will make sure that most of your pts will end up having their Rxs filled at one or more of your competitors.

The play a similar game with the Pharmas,  the pharmas are told if you want your brand name med on their approved formulary, you will pay the PBM a certain percent – claimed to be up to 75% of the AWP (Average Wholesale Price) otherwise the PBM will be require that to get their med paid for will require a PA (prior authorization) and everyone knows that the PBM will suggest to the prescriber a therapeutic alternative that doesn’t require a PA for the pt to get some medication for their health/medical needs.

This year, I ran into a problem with Humana Part D that they would only pay for a particular generic pharma med, even though on their website, they state that the generic is “covered”, HOWEVER, paying CASH for the med was $15.00 LESS than my copay would have been unless a particular pharma’s generic was dispensed.  Where was that extra $15.00 going ?… Probably into Humana’s bottom line, because the rebate/discount/kickback to Humana from the pharma was greater than the generic that my pharmacy stocked and wanted to fill and bill Humana.

If Congress can dictate what a manufacturer can charge for this particular product (Insulin) what will prevent Congress – other than a lot of lawsuits – from telling untold number of manufacturers, retailers and others are allowed to charge for their products and/or how much gross/net profit  a business could legally allowed to make.  Are we on a path for Congress to attempt to nationalize many large businesses…the next step towards socialism ?

 

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