State of the Union Address Highlighted Several ACP Priorities

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President Biden called on Congress to expand Medicare prescription drug negotiating authority, expand price caps on insulin and extend insurance premium tax credits

March 22, 2024 (ACP) -- President Biden's State of the Union address, delivered March 7, emphasized several key priorities of the American College of Physicians that aim to protect consumers and improve access to medical care.

"It was gratifying to see the State of the Union address highlight multiple ACP priorities. We're glad that the president called for Congress to act on these issues," said David Pugach, JD,

ACP vice president of governmental affairs and public policy. "The president called on Congress to expand Medicare prescription drug negotiating authority, expand price caps on insulin and other prescription drugs to private insurers, and extend insurance premium tax credits that help lower-income individuals afford health insurance."

On the prescription drug price front, Pugach noted that "prescription drug costs can be a significant barrier for patients, especially those with chronic conditions. Even the most effective medicines don't work when patients are unable to access them, and patients having to ration prescription drugs or make other difficult choices based on their financial limitations is all too common."

In August 2023, the U.S. Department of Health and Human Services announced the initial list of 10 drugs that would be subject to price negotiation. This list includes drugs that treat diabetes, blood clots, heart disease, psoriasis, rheumatoid arthritis, Crohn's disease and blood cancers. The negotiations are in progress, according to the White House.

An additional 15 Medicare Part D drugs will be added in 2027, 15 Part B and Part D drugs in 2028, and 20 Part B and Part D drugs in 2029.

Lawsuits have been filed that make the future of Medicare prescription drug negotiation somewhat uncertain. In response, ACP has joined multiple friend-of-the-court legal briefs supporting the drug negotiations policy.

In his State of the Union address, President Biden also called for Congress to increase Medicare's negotiating authority to encompass at least 50 drugs a year instead of 20. He wants to extend the $2,000 out-of-pocket spending cap for prescription drugs -- scheduled to begin next year for Medicare beneficiaries -- to include commercial health plans. And he urged Congress to limit Medicare cost-sharing to $2 for high-value generic drugs for all Medicare plans.

President Biden also called on Congress to enact legislation that would limit the cost of insulin across all insurance plans. Under the Inflation Reduction Act, the cost of insulin is now capped at $35 per month under Medicare Part D. This has prompted some manufacturers to voluntarily lower the cost of insulin for many patients.

Affordable Care Act Health Insurance Marketplace tax credits for low- and moderate-income consumers were also mentioned, as the president called on these tax credits to be made permanent. They are now only extended through 2025. This is especially important for people in the 10 states that have not yet expanded their Medicaid programs.

"Efforts to make health care more accessible and affordable and reduce health disparities are essential," Pugach said. "The range of announcements regarding prescription drugs, as well as efforts to promote coverage and payment parity for behavioral and mental health services in Medicare and private insurance, are also really important to patients and their physicians."

Pugach also noted that Biden issued an executive order that aims to protect sensitive personal data. The order "authorizes the Attorney General to prevent the large-scale transfer of Americans' personal data to countries of concern and provides safeguards around other activities that can give those countries access to Americans' sensitive data."

The ACP Medical Informatics Committee is evaluating the administration's proposal. "The committee has guiding principles that recognize that patient misidentification is a growing safety problem amid the increasing proliferation of electronic health information," Pugach said. "We are encouraged by the administration's recognition of the importance of this issue and will be pursuing opportunities to strengthen these policies."

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