HHS Secretary touts drug price protections during Pittsburgh visit with Rep. Lee (WESA FM)

U.S. Rep. Summer Lee and federal Health and Human Services Secretary Xavier Becerra met with health care providers in Pittsburgh Tuesday.

Hosted by Macedonia Family and Community Enrichment Center (FACE) inside the Hill District YMCA, the roundtable discussion focused on federal measures meant to curb prescription costs for seniors. That includes limiting insulin prices to $35 a month for all Medicare beneficiaries.

According to Becerra, any person covered by Medicare who paid more than the new limit for an insulin product so far this year is eligible for a rebate from their insurance. If their provider refuses, residents can seek help from their representatives or by calling Medicare.

“That’s why we’re out here today,” Becerra said. “We want folks first to know what their rights are.”

The rights to which Becerra referred are those included in the Inflation Reduction Act that President Biden signed into law last year. The legislation also gave Medicare the power to negotiate with drug manufacturers over the price of certain high-cost medications.

While the number of medications negotiated is slated to grow over the next several years, Becerra said HHS will begin by identifying 10 “more expensive drugs in America that Medicare pays for” and negotiate the best prices.

“And then pass that savings on to all those Medicare recipients,” the secretary continued.

The agency plans to announce the first round of eligible drugs this fall, although the maximum fair prices it negotiates with manufacturers will not go into effect until 2026.

Together, federal officials predict the reform package is estimated to save Medicare $170 billion over the next decade, with drug negotiations alone reducing spending by approximately $100 billion.

Consumers, too, are expected to save hundreds of dollars from rebates fixed to the rate of inflation—another part of the new law that went into effect in January. Insulin prescription costs averaged around $54 in 2020, 50% more than the $35 cap that went into effect for some Medicare beneficiaries last month.

But the impact of lowering prescription prices goes beyond cost savings, Rep. Lee said.

According to Macedonia FACE CEO Tinisha Hunt, the majority of seniors the organization serves live at or below federal poverty guidelines.

“Sometimes it might mean paying for your prescription drugs or having to buy food or pay another important bill for your basic needs,” Hunt said.

The more people save on their prescriptions, Lee said, the more likely it is they can address their other needs without forfeiting care.

“They’re able to not have to decide between those two very important things, or maybe three very important things they are juggling,” she added. “So, it’s not just the cost-saving; it’s also the life-saving that goes with it.”

Providers speaking Tuesday said the American health care system must also incentivize preventative care. The Medicare measures also require insurers to cover vaccines recommended by the CDC’s Advisory Committee on Immunization Practices, such as the shingles vaccine, at no cost to patients.

Andrea Fox, the medical director of Squirrel Hill Health Center, said that is something her practice couldn’t always afford to provide. It cost more per visit to supply shingles vaccines, she said, than what the organization was able to get covered by Medicaid or Medicare.

“So, we used to send people out to the pharmacy. Now we don’t have to do that anymore. They can continue to get all their care in one place like they’re used to,” Fox explained. “It seems like a little thing, but it is just so great for our patients who are so used to getting all their services all in one place.”

But Fox was among several practitioners who noted that, while the Medicare programs expanded the resources available, behavioral health services covered by Medicare remain limited.

This past December, Congress passed the Mental Health Access Improvement Act, which allows licensed professional counselors and marriage and family therapists to enroll as Medicare providers. They won’t be able to take patients enrolled in the program, however, until January 2024.

“That really disallows so many older adults from getting the behavioral health care that they need,” said Stefanie Small, clinical director at Jewish Family and Community Services.

Life expectancy is higher than ever before, added Allegheny County Department of Human Services Director Erin Dalton. That means people with serious mental illnesses are living longer and need consistent, long-term care, including home care.

“We want to make sure that we best serve those folks, and funding is a real issue there,” she said.

Providers stressed that allowing people to pay less for their prescriptions should make it easier for them to access much-needed preventative care.

That, they say, could ease the burden on health care providers down the road, and begin to shift American health care from a system that only concerns itself with the acutely ill, to one that addresses the whole person.

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