Having multiple treatment options isn’t a luxury, it’s essential to health. Despite this fact, the IRA has significantly altered Medicare Part D and our R&D ecosystem, putting seniors’ access to treatment options at risk. That’s according to a new paper from Hayden Consulting Group.
Every patient is unique, and health care providers must work to identify the best course of treatment to meet each patient’s needs. For example, patients may respond differently to medicines because of their genetics, they might develop a resistance to a medicine, or they may have side effects that are inconsistent with their lifestyle and make adherence difficult. They may also have other co-occurring conditions or be on other medicines, impacting which treatment in a particular class makes the most sense for that individual patient. As a result, a patient may need to try a range of different treatments within the same class of medicines over time.
Take Parkinson’s disease as an example. A range of treatment options are needed and available to help patients manage their symptoms. Effective treatment for an individual patient will depend on multiple factors, including disease stage, age, personal preference of side effects, symptoms and level of disability. In this case, as with many cases outlined in the paper like schizophrenia, diabetes, certain cancers and hepatitis C, having multiple treatment options is crucial for patients and their ability to treat and manage their disease.
But the IRA will limit treatment options in the future. How?
- More access barriers. The price setting provisions on top of the structural changes to Part D significantly alter the financial incentives in the program, and insurers are likely to look for ways to protect their profits and limit their financial risks. As a result, patients could face more utilization management restrictions, delaying their access to medicines. They could see their medicines moved to higher formulary tiers with higher cost sharing, or they could see their medicines excluded from their Part D plan.
- Less R&D means fewer new medicines. The government can now make essentially unilateral decisions about what innovation is valued and what is not, which will drive research and investment away from potentially lifesaving treatment options for Medicare patients. The result is that research-based biopharmaceutical companies will be less likely to invest in research and development after initial FDA approval given the IRA’s drug price setting provisions.
Read the full paper here and learn more at PhRMA.org/IRA.
Nicole Longo
Nicole Longo is Deputy Vice President of public affairs at PhRMA focusing on Medicare, 340B, importation and more. She previously worked for a D.C.-based public affairs firm where she assisted a wide range of clients with communications efforts on everything from trade policy to agriculture policy to health care policy. Outside the office, Nicole can be found trying new restaurants (usually Italian), taking an occasional barre class and cheering on the Cincinnati Bengals.
Nicole Longo
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Government Price Setting
Medicare
Part D
IRA threatens seniors’ access to robust treatment options
IRA threatens seniors’ access to robust treatment options