This could be a big turning point for Floridians who are shelling out thousands a year in prescription drug costs.
Events at the federal and state levels could soon make prescription medications much more affordable to many people in the state with a new federal law as well as a Florida push to allow drug imports from Canada.
“Drug costs have been a problem for Floridians for decades so we welcome some relief,” said Jeffrey Johnson, Florida director for AARP. “When people don’t fill prescriptions because they can’t afford to, or cut the dosage to make a prescription last longer, those are big concerns. High drug costs are clearly jeopardizing the health of patients.”
Gary Abel, 70, shells out as much as $2,000 a month for his diabetes medications until the catastrophic provision of his Medicare Advantage Plan kicks in to pay the full amount, which is usually late in the year. “It’s not just not just insulin, it’s also the other drugs that work with insulin,” said the retired teacher who lives in Boynton Beach. “It’s expensive.”
Abel says he often empathizes with others picking up their medications at the pharmacy. “They say to the pharmacist, how can you charge me that much?”
Now, Abel and other Floridians will get some relief.
A new federal law known as the Inflation Reduction Act will cut prescription drug prices — with some savings taking effect as early as January.
The Act, passed in August, lowers drug costs in five ways for Medicare recipients:
It allows Medicare to negotiate the prices of some high-cost prescription drugs with pharmaceutical companies. The savings will apply to a handful of drugs starting in 2026. Until now, Medicare had been prohibited from from using its huge purchasing power to negotiate drug prices.
It put?s an annual $2,000 limit on how much Part D prescription drug plan members will have to pay out of pocket for their medications.
It requires companies to pay Medicare a rebate if they increase drug prices faster than inflation, which will reduce out-of-pocket costs.
It caps insulin at $35 a month starting in 2023. ( More than 232,000 Florida Medicare beneficiaries used insulin in 2020)
It picks up the full cost for vaccines like shingles starting in 2023.
Unfortunately, Floridians who get health insurance through their employer won’t benefit from the new federal law that penalizes pharma companies for raising prices each year higher than inflation.
However, the new law does allow more Floridians to have insurance coverage, particularly small business owners and self-employed people, which will give them pharmacy benefits. And, the law delays premium increases for people who receive discounted coverage for health insurance provided through Obamacare.
“There’s nothing more top-of-mind for people than their healthcare costs,” said Manny Diaz, chair of the Florida Democratic Party “Everyone benefits from this. This is about making the drugs that save people’s lives more affordable. What could be more important than someone’s health?”
Drug costs are rising
Drug costs are a pocketbook nightmare for many people, and those expenses continue to rise. In 2022, the average price of the top brand-name drugs increased anywhere from 5% to 8%, building on hikes in prior years, according to an analysis from the AARP Public Policy Institute.
Unlike other nations, the U.S. doesn’t directly regulate medicine prices — and some of them are extremely costly.
Drugs to treat diabetes, hepatitis C, rare genetic diseases, multiple sclerosis, chronic granulomatous disease, short bowel syndrome, and lupus are among the most expensive drugs by list price — anywhere from $30,000 to $90,000 a month, according to an analysis by GoodRx Health.
Most Americans spend an average of $1,300 a year out of their own pocket on prescription medicines, and the AARP found older Floridians spend about $1,259.
Floridians who get health coverage through their employer insurance plans will not gain from provisions of the new federal law that imposes a cap on patients’ insulin outlays at $35 a month.
“The insulin cap was supposed to apply across the board,” Diaz said. “They cut that to only apply to Medicare, but it’s still substantial the people who are going to benefit.”
Lower drug prices will make a huge difference in the lives of people like Bruce Sandberg, 70. He lives on a fixed income as a retired teacher and has gastroesophageal reflux as well as high cholesterol. “I don’t spend as much as others but it will be nice that my prescriptions will be free once I reach the $2,000.”
Florida files suit to lower costs
On the state level, another effort is underway to lower drug costs.
Last week, Gov. Ron DeSantis put pressure on the U.S. Food and Drug Administration to allow Florida to import prescription drugs from Canada where prices are lower.
In a lawsuit, Florida’s Agency for Healthcare Administration claimed: “Certain critical prescription drugs can cost Florida almost $400 per pill, putting a significant strain on its healthcare budget.” Florida wants the FDA to approve its import plan immediately.
Those who would benefit from Florida’s drug import plan would be patients under the care of state agencies for conditions including asthma, COPD, diabetes, HIV/AIDS, and mental illness. The Florida Department of Health would distribute the drugs to patients of county health departments as well as pharmacies servicing Medicaid patients; Department of Corrections inmates; state disability center clients; and people in state mental health treatment centers.
If it gets the green light from the FDA, Florida’s Canadian prescription import program is supposed to provide taxpayers as much as $150 million in savings.
DeSantis said all Floridians would benefit from the drug imports because the money from lower drug costs would go to improving access to healthcare services and medications for Medicaid recipients, children, and persons with disabilities or chronic conditions.
Drug costs continue to “pinch people’s budget,” DeSantis said at a news briefing last week to announce Florida’s lawsuit against the FDA. “If we can use this program and be able to contract, even if we just started with state agencies contracting, we’d be able to save 100 million, $200 million for taxpayers, and then, obviously, that will trickle down to consumers and we would be able to expand this.”
Why are drug costs so high?
Americans pick up the cost of research and development for medications that are distributed worldwide. Because of that, they pay more than three times what people in other countries pay for the same medicines, according to a GAO study. For example, Spiriva, used to control asthma, costs $250 per unit in the United States in 2020 and only between $30 and $52 in France, Australia and Canada. Myrbetriq, used to control overactive bladder, cost $164 in the U.S. and only $43 in Canada, the study found.
Some seniors in Florida already turn to mail-order prescriptions from Canada for personal use to keep their costs down.
The debate over the safety of drugs from Canada has been going on for many years. In an executive order issued July 2021, President Joe Biden directed the FDA to work with states to import prescription drugs from Canada and ensure it is done safely.
Along with Florida, states including Vermont, Colorado, Maine, New Mexico, and New Hampshire have enacted laws establishing importation programs for prescription drugs from Canada. Now, it’s up to the FDA to approve Florida’s application, and the agency says only that “we are working on it.”
On top of its efforts to import drugs from Canada, Florida wants to negotiate better prices for medications that people in the state inject such as epinephrine used to treat allergic reactions. Simone Marstiller, secretary of Florida’s Agency for Healthcare Administration, said residents are paying too much for those medications.
“What we are going to do at the Agency for Healthcare Administration is engage a company to get out there and negotiate those prices down, because the time has finally come for us to say not just no, but hell no, we’re not going to continue to pay these prices to the pharmaceutical companies,” Marstiller said during a news briefing on Wednesday.
At the Prescription Pad in Plantation, owner and pharmacist Chris Osborne sees firsthand how much Floridians spend on medications and wants to see them get some relief.
“Seniors really spend a lot out of pocket if you look at the numbers,” he said. “Nowadays you get these new drugs that are coming on the market that are super expensive and there’s no generic form. So I always tell people to tell their doctor to prescribe something generic that is just as good and can still do the job.”
He applauds the new federal law that will cap insulin for seniors. “That’s big because Florida has so many insulin-dependent diabetics,” he said. However, he wants to see caps on more life-saving drugs. “What gets me are that the life-saving drugs are the most expensive drugs and they should be the most affordable … HIV drugs, cancer drugs, insulin.”
Osborne said about 10% of his customers lack insurance and pay for medications out of pocket, so he believes more attention needs to be paid to rising drug costs. “This is a start and I hope it does what it says it’s going to do. But it’s just a start.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.
