Sandy Niebell, of Northampton, has experience with Eliquis and Zarelto.

“I have a lot of cardiac issues. I see a great cardiologist, and I was just recently diagnosed with AFib. It can lead to a stroke without the right medication. I’m allergic to almost everything. I’m that oddball. Allergies happen weeks, days, months after.

“I’ve been on Eliquis for four months. I had to pay more than $1,000 for it. The Medicare copay was very high, and I worried the entire time about how I would be able to afford to continue taking it.

“Then I got itchy. Last week, it was so bad I went to see my cardiologist. They wanted me to try Xarelto, but the price is crazy high. If you look on GoodRx, the price is $3,200-some dollars. So he said, ‘Go with the generic of Pradaxa.’ So I got that. It cost me $88. And three days later ... I ended up in the ER. Itching (and) scratching. My sheets are bloody.

“I’d like Medicare to negotiate lower prices, not only for me, but for everyone. These prices never should have been this high. We seniors, we have enough to worry about. And the doctor should not have to listen to me whine about the cost every time he sees me. We and our doctors shouldn’t have to make life and death decisions based on how much a drug costs.”

Niebell spoke at an event at Lehigh Valley Active Life in September geared toward highlighting the positive impact Medicare negotiation for fair prescription drug prices will have.

In October 2022, President Joseph Biden issued an executive order on lowering prescription drug costs for Americans as part of the Inflation Reduction Act.

“Too many Americans face challenges paying for prescription drugs. On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly 3 in 10 American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost,” the executive order states.

My grandmother would cut her drugs in half to save money, when in fact, she needed the full dose.

A friend, who works full time with good insurance, needs a drug at a cost of $700 for a three-month supply. Her response to the price? “I’m just not going to take it.”

And what about those who are not on Medicare without insurance?

U.S. Rep. Susan Wild, D-7th, attended the event at Lehigh Valley Active Life to talk about her efforts to lower prescription drug costs.

“If you know me, you know the work to get drug prices down is something I’ve been at for a long time, since back when I first came to Congress. Back in 2019, I secured changes to protect consumers from pharmaceutical exclusivity provisions that would’ve locked in policies keeping drug prices outrageously high.

“In the next several years, I pushed hard, time and again, to empower Medicare to negotiate drug prices – from leading my colleagues in requests to our leadership to include the Medicare negotiation in House-passed legislation, urging that it be included in reconciliation, and finally seeing the results of those efforts when the Medicare negotiation provision was included in the Inflation Reduction Act. You may have heard me say before that it’s because of this work that I’m known as a ‘dog with a bone’ when it comes to my work on lowering drug prices.

“We are chipping away at decades of Big Pharma greed and price gouging by allowing Medicare to directly negotiate on prescription drug costs and get a fair deal for our seniors. This is a win that will help millions of Americans save money on their health care.

“My focus continues to be on getting costs down for people in our community. From helping empower Medicare to negotiate drug prices and get costs down, to the work ahead to ensure everyone can afford the medication they depend on, I’ll keep doing everything I can to make that happen,” Wild said.

Wild’s office provided the following facts about Medicare drug price negotiations.

• Medicare drug price negotiation was made possible by the Inflation Reduction Act, legislation Wild worked to pass into law.

• In 2022, about 9 million Medicare enrollees used the 10 drugs selected for the first round of negotiation.

• More than 455,000 Pennsylvanians used the 10 drugs selected for negotiation and will see lower costs thanks to Medicare negotiation.

• The negotiation program is projected to save the government $98.5 billion by 2031 and reduce insurance premiums and out-of-pocket costs for Medicare recipients.

• Medicare enrollees paid a total of $3.4 billion in out-of-pocket costs for the 10 drugs selected for negotiation during 2022.

• In 2022, Pennsylvanians paid as low as $140 and as high as $5,687 out-of-pocket per year on average, depending on the drug. Across the country, seniors paid as much as $6,497 in out-of-pocket costs per year for just one of these drugs.

• By Sept. 1, 2024, the Centers for Medicare and Medicaid Services will release the maximum prices for these drugs. These prices will become effective Jan. 1, 2026. In the future, CMS will select for negotiation up to 15 more drugs for 2027, up to 15 more drugs for 2028 (including drugs covered under Part B) and up to 20 more drugs for each following year.

The first 10 drugs eligible for negotiations include the following.

1. Eliquis (Bristol Myers Squibb and Pfizer) for preventing strokes and blood clots

2. Jardiance (Boehringer Ingelheim and Eli Lilly) for diabetes and heart failure

3. Xarelto (Johnson & Johnson) for preventing strokes and blood clots

4. Januvia (Merck) for diabetes

5. Farxiga (AstraZeneca) for chronic kidney disease

6. Entresto (Novartis) for heart failure

7. Enbrel (Amgen) for arthritis and other autoimmune conditions

8. Imbruvica (AbbVie and Johnson & Johnson) for blood cancers

9. Stelara (Johnson & Johnson) for Crohn’s disease

10. Fiasp and NovoLog insulin products (Novo Nordisk) for diabetes

Although this negotiation is handled at the federal level, our local state representatives also hear from constituents struggling with the high cost of prescription drugs.

“Unfortunately, in state government, members of the General Assembly are limited in their ability to directly address this, but state Rep. Ryan Mackenzie, R-187th, has been able to help provide additional options for Pennsylvanians to potentially reduce their costs,” Paige Riegner, chief of staff for Mackenzie, said.

“Recently, a constituent contacted Rep. Mackenzie regarding Amazon RxPass not being offered in Pennsylvania. Rep. Mackenzie met with Amazon to discuss how RxPass could be offered in our state and learned it was due to Pennsylvania regulations not keeping pace with other states. After Amazon was about to meet with the Department of Health to discuss this regulatory challenge, the issue was able to be worked out, and RxPass is now available to Pennsylvanians,” Riegner said.

“We also hear from our senior constituents regarding their Medicare plans, which is why we partner with PA MEDI (Pennsylvania Medicare Education and Decision Insight) to offer assistance during open enrollment. Once a week, Oct. 15 to Dec. 7, a representative offers free counseling to seniors during the open enrollment period. Appointments are necessary and interested seniors should contact the office at 610-965-9933,” Riegner added.

For me, the idea of paying $1,000 or $3,000 for necessary medication is outrageous! It doesn’t seem like a solution can come fast enough for those affected and especially our seniors.

No one should have to choose between life-saving drugs and everyday expenses, such as food and home costs.

Debbie Galbraith

editor

East Penn Press

Salisbury Press