Opinion: It’s open enrollment time for Medicare, and it’s better than ever thanks to changes by Biden and Baldwin

Starting in 2026, the prices for these drugs will decrease for up to nine million seniors, thanks to a provision in President Biden’s Inflation Reduction Act that allows Medicare to negotiate the prices for these drugs directly with the manufacturers. (Photo via Shutterstock)

By Dr. Lynn Carey, PhD RN

November 20, 2023

The Inflation Reduction Act ended 30 years of taxpayers not being able to use their buying power to get lower prices from big drug companies.

“Finally.”

That was my first thought after the Inflation Reduction Act passed. Because for 30 years Medicare had been banned from using its bulk purchasing power to negotiate for lower drug prices.

“Thank goodness for Joe Biden and Tammy Baldwin,” was my second thought. Democratic presidents have been trying to lower drug costs for decades. This one got it done with the help of Democrats in Congress. Yes, only Democrats. Not a single Republican member of Congress voted for the Inflation Reduction Act.

I was reminded of those initial thoughts as Medicare open enrollment began last month, giving millions of seniors the window to select their health coverage for next year. As part of the effort to promote open enrollment I had the opportunity to appear with Sen. Baldwin at an event in Waukesha to tell my story.

My story isn’t unique. At least I don’t think it is. But I believe that Wisconsin seniors should know that Medicare is better than ever as this enrollment period began, so I shared it with the senator and those in attendance.

I was diagnosed with pulmonary hypertension in 2004 and received a double lung transplant a little more than 10 years later. Between the hypertension and post-op drugs to ensure the transplant was successful, I have seen some eye popping costs for drugs that are needed just to survive.

Then two years ago I was diagnosed with atrial fibrillation (or Afib) which requires the medication Xarelto. Taking Xarelto is extremely important because it helps prevent strokes and blood clots related to Afib. Between Medicare Part D and my supplemental coverage I can manage the cost, but it’s not easy.

For others, I know it is virtually impossible—leading to heartbreaking decisions like whether to take prescribed doses of essential medications or stretch them out over a longer period of time so the utility bill can get paid.

The Inflation Reduction Act signed into law by President Biden includes five major provisions to drive down prescription drug costs and make things a little easier for those in that position.

First, it caps monthly insulin costs at $35 per prescription. Skipping or limiting insulin doses can lead to severe complications, including death.

Second, people on Medicare have access to critical vaccines—such as shingles and pneumonia—for free. Previously, seniors may have had to pay up to $424 for the shingles vaccine. These high costs led to low vaccination rates, particularly for people of color, putting many at risk for serious but preventable complications from shingles, such as long-term nerve pain, blindness, and brain inflammation. Now, more than 61 million Americans on Medicare can get the vaccine for free.

Third, this legislation stops drug companies from raising Medicare drug prices faster than the rate of inflation. Year after year, the prices of medications have been raised far beyond the inflation rate, forcing more than one in five seniors not to take medication as prescribed.

Fourth, the Inflation Reduction Act caps out-of-pocket drug costs for seniors on Medicare at $2,000 per year, saving nearly 19 million Americans an average of $400 each year. Seniors like me with serious health conditions will save thousands of dollars on prescriptions under this provision. Thanks to this bill, more than 3 million seniors could see savings of more than $1,500 a year, starting in 2025.

Finally, as mentioned above, the Inflation Reduction Act finally gives Medicare the power to negotiate lower drug prices beginning this fall. The first round of ten high-cost prescription drugs selected for negotiation are taken by nearly 9 million people on Medicare, who spent $3.4 billion in out-of-pocket costs last year alone. Xarelto, which I need to treat my a-fib, is one of those first ten.

Unfortunately, all of these Inflation Reduction Act’s cost-saving measures are at risk. Not only have Republicans fought for decades to cut and privatize Medicare, but they are continuing their pursuit of ripping affordable and accessible health care away from American seniors. From drafting new legislation to leveraging their influence in the courts, they have returned to some of their oldest schemes to repeal the new Medicare benefits included in the Inflation Reduction Act and put drug companies back in charge at the expense of seniors across the nation.

That’s wrong. And we can’t let it happen. Which is why I’m using my voice to spread the truth: Medicare has never been better. And it’s that way because of Democrats like Joe Biden and Tammy Baldwin.

Lynn Carey is a retired nurse and nursing professor who lives in Germantown, WI.

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