In-Depth: How will the Inflation Reduction Act Impact Prescription Drug Prices for Seniors?

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ROCHESTER, N.Y. — Most Americans over the age of 65 rely on at least 4 prescription medications and with the average cost of those drugs higher in the U.S. compared to any other nation, many seniors are forced to make difficult decisions based on what they can afford.  If passed by the house and signed by the President, the Inflation Reduction Act may help.  

Susan Hunter is a 72 years-old diabetic with heart issues.  She’s on 10 different medications, more than half of which cost $60 each per month to refill. “Sometimes you just get overwhelmed, you just don’t know where to go or what to do anymore and I hate to be a burden on my kids,” she tells News10NBC.

Hunter says she often has to pick and choose which prescriptions to fill. “I can’t afford it, I have to make a choice of what I’m going to take because I mean I’m trying to live, I’m trying to survive but I never thought I’d get to be this age and have to make choices like this in life,” she says.

There are millions of older Americans like Hunter making the same choices.  Some provisions in the Inflation Reduction Act aim to change that. 

If signed into law, starting in 2025, seniors on Medicare will have a $2,000 annual cap on out-of-pocket drug expenses.  In 2026, for the first time, Medicare will begin negotiating its own drug prices starting with 10 high-cost drugs that are highly prescribed.  The change that starts the soonest, in 2023, is a $35 monthly cap on insulin for those on Medicare. 

The changes impact only those on Medicare, not people with private insurance. “The challenge in the Senate is they have to use a special rule to get this bill done and that rule will only allow you to make changes that affect most directly the federal budget,” explains Congressman Joe Morelle who said he fully intends to vote in favor of the Inflation Reduction Act when the house votes on it later this week. 

Congressman Morelle says in the meantime, he’s hoping the changes to Medicare can at least be used as a negotiating tactic by private insurers. “Many private insurers and the drug formularies that negotiate in the managed care organizations hopefully they’ll be able to point to the Medicare numbers and say, “well look Medicare is only paying X so as someone who has 10,000 subscribers or 100,000 subscribers we want that price as well,” he tells News10NBC. 

Hunter thinks the changes sound good but she’s worried about the time it’ll take to get them into place. “Even if it’s too late for me, it might help another generation you know what I mean because I’m already to the point where I’m kind of tired you know, I’m just tired, I’m tired of making choices you just get to the point or you know whatever works, works,” she says.