November 2021

Last week, the Centers for Medicare & Medicaid Services announced an increase in Medicare Part B premiums, due to the out of control rise in prescription drug prices. All Medicare beneficiaries will feel the impacts of this increase, which will make it more expensive to visit a physician and receive outpatient care, all because Republicans in Congress refuse to empower Medicare to negotiate the cost of life saving medication for seniors. This simply cannot continue. The Build Back Better Act will put a check on Big Pharma’s price gouging, lower costs, and ensure seniors are able to access the prescription drugs they need to live full and healthy lives. 

Big Pharma’s Greed Forces Medicare To Increase Premiums

Aduhelm Alone Increases Medicare Premiums For Seniors. Premiums for 56 million Medicare Part B beneficiaries will be impacted due to one drug company’s greed and the outrageous price of Aduhelm, Biogen’s controversial new Alzheimer’s drug. Aduhelm’s $56,000 annual precise tag has forced Medicare to establish a contingency reserve in the event Medicare decides to cover the medication. 

Cost-Sharing Requirements For Seniors Will Increase. Aduhelm’s astronomical price will expose six million Medicare beneficiaries with no supplemental coverage to the full brunt of Medicare’s cost-sharing requirements. This cost sharing responsibility for Part B medications, like Aduhelm, will be particularly painful for the 90 percent of Medicare Advantage beneficiaries with plans requiring 20 percent coinsurance rates for in-network providers, with that figure surging to 50 percent for medications provided out-of-network. 

Lowering Costs & Keeping Big Pharma In Check

High Drug Prices Cause Higher Premiums. The excessive cost of prescription drugs is felt far beyond the pharmacy counter. High medication costs are reflected in higher insurance premiums for seniors on Medicare, individuals purchasing insurance on their own, and for employers providing coverage to their workers.

Build Back Better Will Lower The Cost Burden On Seniors. By giving Medicare the power to negotiate prescription drug prices and preventing drug companies from raising the cost of medications faster than inflation for all Americans, Build Back Better will lower the cost of health care across the board. When drug prices skyrocket, premiums increase. By requiring the pharmaceutical industry to play fair, Medicare will serve as a check on arbitrary and extreme prices set by drug makers.

Republicans In The Pocket Of Big Pharma Are Blocking Reform

Republicans Teaming Up With Pharma To Kill Drug Provisions. In 2021 alone, Big Pharma has spent nearly $263 million on lobbying — devoting three lobbyists to each member of congress. This strategy has worked on Republicans, now promising to “challenge anything and everything” in order to protect drug companies’ profits while millions of families struggle to afford the medications they need to survive.

Republicans Continue To Carry Water For Pharma. While Republicans are busy peddling Big Pharma’s lies, Democrats are working to make prescription drugs affordable. Medicare drug price negotiation included in the Build Back Better Act allows the federal government to establish fair prices with drug makers, not decide what medications Medicare beneficiaries can and cannot access. Republicans are attempting to scare the public with false statements about restricting innovation and government interference in health care, but the American people know better. Polling has clearly demonstrated that giving Medicare the power to negotiate drug prices is one of the most popular provisions in Build Back Better.

Washington, D.C. — Today, Senator Patrick Leahy (D-VT) announced his intention to retire after serving for 46 years in the U.S. Senate. During his time on Capitol Hill, Senator Leahy played an essential role in passing and protecting the Affordable Care Act, fighting for a future where every American has access to quality, affordable health care. 

“During his long and distinguished tenure in the United States Senate, Senator Leahy was a relentless defender of health care and of the Affordable Care Act,” said Protect Our Care Chair Leslie Dach. “I had the privilege to work for Senator Leahy as a member of his committee staff nearly 35 years ago, and his passion, integrity and commitment to justice and to the country left an indelible mark. America, and all of us who learned by seeing him do his job, owe him a debt of gratitude.”

“Senator Leahy is a true health care champion, and his leadership will be sorely missed in the Senate,” said Protect Our Care Executive Director Brad Woodhouse. “For 46 years, Senator Leahy has fought tirelessly to expand and protect health care for Vermonters and all Americans, including playing a leading role in working to protect the Affordable Care Act at the Supreme Court last year. We wish the senator all the best in his retirement, and we will keep up the fight to ensure health care is a right for every American.” 

Washington, D.C. — As Democrats in Congress are on the cusp of passing the Build Back Better Act, new reporting indicates Republican lawmakers are focused on blocking a key provision that lowers prescription drug prices for working families. A pharmaceutical lobbyist revealed to Politico that the Republicans’ “operating plan” is to challenge any provision that would rein in the high costs of prescription drugs. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“Time and again, Republicans are ready to carry water for Big Pharma. The news of Republican lawmakers challenging any provision that would lower drug prices is just confirmation they are committed to protecting drug company profits until the bitter end. For years, Republicans have protected the broken system that allows drug companies to dictate whatever price they want to charge while millions of families struggle to afford the medications they need to survive. Big Pharma and its Republican allies recognize that the status quo ends with the Build Back Better Act, which works to put an end to outrageous price hikes and gives Medicare the power to negotiate for lower drug prices. Fortunately, President Biden and Democrats in Congress are committed to putting an end to Big Pharma’s greed and finally bringing down drug prices.” 

New polling from Navigator Research released yesterday confirms that health care reforms remain the most popular part of President Biden’s Build Back Better Act. The poll found that voters believe that the measures to lower drug prices, bring down insurance premiums, and expand Medicare are the top reasons Congress should pass the Build Back Better Act. Other polling has consistently shown public support for these reforms.

A closer look at the results: 

Voters Agree the Best Reasons to Pass Build Back Better Are Medicare Negotiation for Lower Drug Prices, Expanding Medicare, and Reducing the Cost of Health Insurance. When it comes to policies that affect them directly, voters say giving Medicare the power to negotiate, expanding Medicare benefits, and making insurance more affordable are the best reasons to pass the plan. 

As Democrats are set to pass the Build Back Better Act next week, Republican lawmakers are fighting to block its most popular provision: giving Medicare the power to negotiate lower prescription drug prices. A closer look at campaign contributions reveals these GOP lawmakers are deeply tied to big drug companies, which explains why Republicans are spreading lies and trying to mislead the American people. In reality, voters across the political spectrum are demanding action to reign in Big Pharma’s greed and lower drug prices now. 

Republican House Leader Kevin McCarthy: “Democrats are working overtime to eliminate innovation in new drugs and therapeutics and to allow Washington bureaucrats to decide which drugs seniors can take.” [11/5/21]

FACT CHECK: Medicare drug price negotiation included in the Build Back Better Act allows the federal government to establish fair prices with drug makers, not decide what medications Medicare beneficiaries can and cannot access. A 2017 report from the National Academies of Medicine on lowering costs and protecting innovation concluded, “drugs that are not affordable are of little value.” Build Back Better works to ensure Americans have access to the medications they need at prices they can afford. 

PHARMA INFLUENCE: Rep. Kevin McCarthy was the number one recipient of contributions from the pharmaceutical manufacturing industry in 2020, receiving $242,353 in contributions.

House Republican Conference Chair Elise Stefanik: “Under Pelosi’s plan, these companies would be forced to cut research and design spending on new drugs, leading to fewer cures and lifesaving breakthroughs for individuals and families most in need of hope.” [6/4/21]

FACT CHECK: Deciding between lowering drug prices and ensuring innovation is a false choice. Between 2016 and 2020, 14 leading drugmakers spent $577 billion on stock buybacks and dividends—$56 billion more than what was invested in research and development over the same period. One company, Amgen, spent nearly six times more on executive pay, buybacks, and dividends than it did on research and development in 2018. 

PHARMA INFLUENCE: In the 2020 election cycle, Rep. Elise Stefanik received $67,956 from the pharmaceutical/health products industry. She has received an additional $6,043 for the 2022 cycle.

Energy & Commerce Ranking Member Rep. Cathy McMorris Rodgers: “More federal command and control over our health care will lead to less innovation [and] fewer cures.” [10/19/21]

FACT CHECK: Research has demonstrated that impacts from lowering drug prices can be successfully mitigated by large pharmaceutical companies reducing their spending on things like stock buybacks and dividends. This is not a make or break issue for the pharmaceutical industry. Drug companies could lose $1 trillion in sales, while maintaining research developments, and still be the most profitable industry, because pharmaceutical companies enjoy profit margins nearly three times the average for the S&P 500. Between 2000 and 2018, 35 large drug companies raked in a combined revenue of $11.5 trillion with a gross profit of $8.6 trillion — far more than other large companies. 

PHARMA INFLUENCE: Rep. Cathy McMorris Rodgers has received nearly $60,000 from the pharmaceutical manufacturing industry so far in the 2022 election cycle. Rep. McMorris Rodgers is the number one Republican recipient of contributions from the pharmaceutical manufacturing industry in the 2022 election cycle. So far their contributions have totaled $57,760.

Rep. Devin Nunes: “The Democrats… say that to bring [down] the cost of drugs, we have to take back government control of prices. That we must sacrifice our world-leading innovation in treatments and cures to lower costs at the pharmacy counter for seniors.” [10/14/21]

FACT CHECK: Major drug companies often outsource research and development. A 2019 analysis from Stat found a majority of top-selling drugs from two of the largest drug companies — Pfizer and Johnson & Johnson — were discovered and developed by third parties, such as universities and academic centers. These findings suggest that “a reduction in pharmaceutical revenues would not have the supposed devastating impact on the level of biopharmaceutical innovation.” 

PHARMA INFLUENCE: In the 2020 election cycle, Rep. Devin Nunes received $121,283 in total contributions from the pharmaceutical/health products industry. He has received an additional $16,722 for the 2022 election cycle so far. 

Sen. Tim Scott: “From curing rare diseases to increasing life spans by many years, recent medical advancements have been nothing short of miraculous for seniors and other at-risk populations. Handing over drug pricing to the federal government would halt that positive momentum and put life saving medications further out of reach for too many Americans.” [10/1/21]

FACT CHECK: Time and again, drug companies hike the prices of drugs without any added benefit to patients. According to Patients for Affordable Drugs, a vial of band name insulin costs about $4 to make but costs $270 and one capsule of the cancer drug Revlimid costs less than a dollar to make but sells for $833. 

PHARMA INFLUENCE: The pharmaceutical industry has donated $270,773 to Sen. Tim Scott for the 2022 election cycle. In his career since 2009, Sen. Tim Scott has received nearly $750,000 from the pharmaceutical industry.

***MEDIA ADVISORY FOR TODAY, NOVEMBER 10 AT 12:00 PM EST***

Augusta, ME — Today, Wednesday, November 10 at 12:00 PM ET, state lawmakers and local health care advocates will join Protect Our Care Maine, calling on Congress to immediately pass the Build Back Better Act. The coalition will also discuss significant health care provisions in the Build Back Better Act —including giving Medicare the power to negotiate lower drug prices, addressing the Medicaid coverage gap, and much more — to lower costs and improve access to health care.

This transformative act by President Biden and Democrats in Congress will reduce racial disparities in health care, create healthier communities, and strengthen the economy. The health care measures in Build Back Better will lower costs and improve and expand access to lifesaving care. Once passed by Congress and signed into law, the Build Back Better act will be the most significant expansion of affordable health care since the passage of the Affordable Care Act. 

VIRTUAL EVENT:
WHO:
Maine State Senate President Troy Jackson
Ann Woloson, Maine Consumers for Affordable Health Care
Marie Follayttar, Mainers for Accountable Leadership
Sharon Pelletier-Ayer, Bangor Resident
Brad Woodhouse, Protect Our Care Executive Director 

WHAT: Virtual Press Conference Calling on Congress to Pass Build Back Better Act With Health Care Provisions Including Medicare Negotiations to Lower Drug Costs

WHERE: Register for the Event Here 

WHEN: Wednesday, October 10 at 12:00 PM EST

New reports indicate big drug companies are fighting to weaken the parts of the Build Back Better Act that deliver relief to families and give Medicare the power to negotiate for lower prescription drug prices. As Big Pharma continues its fight against Medicare negotiation, here are four big reasons why America’s families reject drug companies’ claims and are demanding action now: 

HIGH PRICES

SHOT: Drug Companies Hiked The Prices Of Nearly 1,000 Drugs In January. Drug companies started 2021 by hiking the prices of hundreds of drugs. In January of 2021, more than 900 brand name drugs experienced price increases, the highest in over a decade. GoodRX found the increases to be the “largest number of increases in years.” 

CHASER: Americans Don’t Trust Pharmaceutical Companies On Pricing. Three in four Americans do not trust drug companies to price their products fairly, with the vast majority of Americans identifying the high cost of prescription drugs to be the result of Big Pharma’s greed. 78 percent report pharmaceutical company’s profits are a major factor contributing to the soaring cost of medications.

POWER & INFLUENCE

SHOT: Pharmaceutical Industry Spent Over $250 Million Trying To Kill Medicare Negotiation. In 2021 alone, Big Pharma has spent nearly $263 million on lobbying — devoting three lobbyists to each member of congress.

CHASER: Americans Dislike Pharma’s Influence In Washington. 72 percent of Americans say the pharmaceutical industry has too much influence over the federal government.

INNOVATION LIES

SHOT: Drug Companies’ Stock Buybacks And Dividends Exceed R&D Spending. Between 2016 and 2020, 14 leading drugmakers spent $577 billion on stock buybacks and dividends—$56 billion more than what was invested in research and development over the same period. One company, Amgen, spent nearly six times more on executive pay, buybacks, and dividends than it did on research and development in 2018.

CHASER: Majority Of Americans Don’t Buy Pharma’s Innovation Argument. Roughly 70 percent of Americans are not convinced by the pharmaceutical industry’s argument that drug price negotiation will harm its ability to fund research and development.

SKY-HIGH PROFITS 

SHOT: Drug Companies Enjoy The Highest Profits Of Major Industry. Pharmaceutical companies experience profit margins nearly three times the average for the S&P 500. Between 2000 and 2018, 35 large drug companies raked in a combined revenue of $11.5 trillion with a gross profit of $8.6 trillion — far more than other large companies. Drug companies could lose $1 trillion in sales and still be the most profitable industry. 

CHASER: Americans Hold Overwhelming Negative Views Of The Pharmaceutical Industry. A 2019 Gallup poll found the pharmaceutical industry to be “the most poorly regarded industry in Americans’ eyes.” The critique of Big Pharma included their seemingly never ending price increases, massive lobbying influence, and role in the opioid crisis, proving distrust of the pharmaceutical industry is far reaching.

Democrats in Congress reached a historic agreement to lower prescription drug prices for all Americans through the Build Back Better Act.

For 20 years, drug companies have benefited from a law that bans Medicare from negotiating lower prices for patients. As a result, Americans pay three times more for the same drugs as people do in other countries. Build Back Better will give Medicare the power to negotiate lower prices once and for all, and it will cap seniors’ out-of-pocket drug costs, stop excessive price increases for existing medications, and limit insulin copays to $35 per month for diabetics.

Even as Congress has landed on a deal, Big Pharma has continued to deploy its vast warchest – and a series of well-funded front groups – to mislead, distort and outright threaten patients in their effort to hold on to their staggering prices and profits.

Almost all of them are channeled through groups with patient-friendly names that have one thing in common: drug industry money or connections. 

This updated report details how the many major ad campaigns currently running against prescription drug price reform are actually backed by pharmaceutical industry funds. The ads are paid for by the same people who profit by keeping the prices artificially high and protecting their monopoly while millions of American families cannot afford life saving medicines.

REVEALED: PHARMA’S CAMPAIGN TO STOP LOWER DRUG PRICES

Pharmaceutical Research and Manufacturers of America (PhRMA)

PhRMA Is Spending Millions Misleading The American People. In September, PhRMA launched a 7-figure ad buy against drug price negotiation proposals moving through Congress. The tPhRMA is out with twoa new advertising campaigns intended to make Americans fear Medicare drug price negotiation by claiming politicians will decide what drugs patients can get. The ad, featuring Sue — a Type 1 diabetic,  made such outrageous claims about restricting patients access to needed medications, the Washington Post gave it a ‘Three Pinachios’ rating and said the ad was PhRMA’s attempt to claim “there are provisions in the legislation that do not exist.” In 2021, a CBO working paper estimated that if Medicare was empowered to negotiate drug prices, they would “fall between 57 percent and 75 percent, relative to current prices.” Factcheck.org agrees that Medicare negotiation would not prevent beneficiaries from accessing medications and PhRMA’s ads are an “inaccurate portrayal of recent legislation.”

PhRMA Cannot Be Trusted With Drug Pricing Reform. PhRMA represents the nation’s leading biopharmaceutical companies. Americans see through the fear tactics used by pharma industry trade groups, with 75 percent of Americans reporting they do not trust the industry to fairly price prescription drugs.

PhRMA Spent More Than $20 Million On Lobbying In 2021 So Far. According to OpenSecrets, PhRMA has spent $22.9 million on lobbying in 2021 so far. PhRMA is on track to break their 2019 lobbying spending record of $29.3 million this year. According to research by Patients For Affordable Drugs Now, PhRMA and its front groups have spent at least $26.5 million on television and digital ads against Medicare drug price negotiation between July and November of this year.

American Action Network (AAN)

American Action Network Is Funneling Millions Into Misinformation Campaigns. AAN is currently running a $5 million advertising campaign, claiming the recent budget resolution is “a socialist prescription drug plan that would limit patients’ access to lifesaving medications.” In reality, the resolution would allow Medicare to negotiate fair prescription drug prices, something 88 percent of Americans strongly support. In 2019, AAN received $4.5 million from PhRMA, the largest contribution made by the trade group that year. 

American Action Network Has Received Millions From A Pharmaceutical Trade Group. AAN has a long history of accepting funds from the pharmaceutical industry. A year after the group’s formation, AAN took $4.5 million from PhRMA. This trend has continued, with AAN receiving nearly $15 million from PhRMA between 2016 and 2019.

Medicare Today

Medicare Today Is Not Telling The Whole Story. Medicare Today launched an advertising campaign, claiming that 92 percent of seniors are “satisfied” with Medicare. What Medicare Today failed to mention is while seniors support the program, they are also strongly in favor of improving Medicare and lowering drug costs. The majority of seniors support allowing the government to negotiate prescription drug prices (82 percent), placing a limit on out-of-pocket drug costs (68 percent), and lowering the amount Medicare pays for drugs based on amounts in other countries (60 percent). 

Medicare Today Was Launched By Big Pharma Executives. Medicare Today was launched in 2004 by the Healthcare Leadership Council, a coalition of health care executives, which includes the pharmaceutical industry. Healthcare Leadership Council includes the drugmakers: Amgen, Biogen, Bristol-Myers Squibb, Johnson & Johnson, Merck, and Pfizer.

Partnership to Fight Chronic Disease

Partnership To Fight Chronic Disease Is Using Big Pharma’s Tired Scare Tactics. The Partnership To Fight Chronic Disease is running a new advertising campaign claiming drug price negotiation will stifle innovation and reduce patient access to lifesaving drugs. The CBO analyzed the impact of a decrease in pharmaceutical revenue by as much as $1 trillion and found that it would only have a modest impact on drugs coming to market (impacting approximately eight of the 300 new drugs expected in the next decade). Only 10 percent of drugs that have entered the market over the last 50 years have represented therapeutic advances, with drugmakers making deliberate choices not to invest in research and development, and instead focusing resources on obtaining patents on old drugs, in order to “extend patent protection, prolong monopoly pricing periods, and keep generic competitors off the market.”

Partnership To Fight Chronic Disease Is Funded By Big Pharma. It is no wonder why the Partnership To Fight Chronic Disease is working so hard to protect the bottom line of drugmakers — they are an affiliate of Pharmaceutical Research & Manufacturers of America, which represents biopharmaceutical corporations. Over the past 10 years, the Partnership To Fight Chronic Disease has listed PhRMA officials as key employees on tax forms and despite running multi-million ad campaigns, the organization has not reported fundraising costs since its founding in 2007. 

Pharmaceutical Industry Labor-Management Association (PILMA)

PILMA Is Making False Claims That Medicare Price Negotiation Will Damage Innovation. PILMA is running an advertising campaign claiming that Medicare price negotiations would harm innovation and make it harder for patients to access their medications. This is simply not true and fails to recognize that under our current system, nearly one in three Americans report not taking a medication as prescribed due to cost. A 2017 report from the National Academies of Medicine found, “drugs that are not affordable are of little value.”

PILMA Cannot Be Trusted With Drug Pricing Reform. PILMA is a coalition of biopharmaceutical companies and labor unions. Americans recognize that Big Pharma is putting profits over people, with 80 percent of Americans reporting the pharmaceutical industry’s profits as a “major factor” for the high cost of prescription drugs. 

60 Plus Association 

60 Plus Association Is Fighting Medicare Price Negotiation. The CBO found Medicare drug negotiation would save patients more than $150 billion at the pharmacy counter, yet 60 Plus Association is running an advertising campaign, attempting to sell Medicare negotiation as a ‘scam’. In reality, it is 60 Plus that has been deceiving the public. In 2016, the Koch Brother affiliated organization was fined by the Federal Election Commission after violating federal rules requiring they identify the source of funds earmarked for political expenditures. 60 Plus, along with two other Koch affiliated groups, consented to pay a total of more than $200,000. The New York Times referred to the investigation as “a look…into the interlocking networks of political nonprofits on the right, through which vast sums of money flow each election cycle with little disclosure.”

In September 2021, 60 Plus released another ad campaign referring to the $500 billion saved by the government from drug price negotiation as “cuts to Medicare.” KHN and Politifact agree that this is misleading since the $500 billion would not be “swiped” by Democratic leaders, but would be used for reinvestment in Medicare hearing expansion.

60 Plus Association Has Received Millions From The Drug Industry. It is clear who has been holding the reins at 60 Plus. In 2002, 91 percent of its $12 million revenue came from a single donor, which Public Citizen presumes to be PhRMA. 60 Plus has also received money from drugmakers like Pfizer, Merck, and Wyeth-Ayerst.

One Nation

One Nation Is Burying the Lede. One Nation is running a new advertising campaign claiming “good health care is hard enough to get” and that Medicare drug price negotiation would restrict access to lifesaving drugs. What One Nation fails to mention is one of the leading limitations to health care access is the soaring cost of prescription drugs. 29 percent of Americans taking prescription drugs have reported not filling, halving, or skipping a needed prescription due to cost in the past year.

A Big Pharma Lobbyist Sits On One Nation’s Board. One Nation added Ken Cole, former lobbyist for Pfizer and Chamber of Commerce board member, to their board in 2019. Pfizer and the Chamber of Commerce have spent a collective $1 billion on lobbying over the last decade, including on efforts to kill legislation aimed at lowering the cost of prescription drug prices. 

National Association Of Manufacturers

National Association Of Manufacturers Falsely Link Price Setting With Decreases In Innovation. The National Association of Manufacturers released an ad campaign in early October falsely linking Medicare price negotiation with decreases in innovation for “life-saving cures and vaccines.” The Harvard Business Review found that even though Medicare negotiation would lead to 2 fewer drugs in the next decade and 23 fewer in the following decade, price setting would not lead to decreased innovation as many of these drugs would be modified versions of already existing drugs.

PhRMA Is A Member of NAM. NAM member organizations represent a plethora of different industries like textile manufacturers, paper products, and the meat industry. PhRMA is a member of NAM and has been able to successfully air ads attacking Medicare negotiation under the NAM branding.

In the coming days, Congress will pass the Build Back Better Act, historic legislation that will drive down health care costs and level the playing field for working families. Central to the Build Back Better Act is giving Medicare the power to negotiate for lower drug prices. Big Pharma has spent more than $250 million to try to stop it, but the American people remain unswayed. 

Polling clearly shows the American people do not trust the pharmaceutical industry. After years of putting profits over people and pushing life saving medications out of reach, Americans have had enough.

Americans Do Not Trust Drug Makers To Set Fair Prices. With skyrocketing price increases year after year, three in four Americans do not trust drug companies to price their products fairly. 

Americans Believe Big Pharma Puts Profits Over People. The vast majority of Americans, from across the political spectrum, because the high cost of prescription drugs is caused by Big Pharma’s greed. 78 percent report pharmaceutical company’s profits are a major factor contributing to the soaring cost of medications.

Americans Believe Pharmaceutical Companies Have Too Much Influence. 72 percent of Americans say the pharmaceutical industry has too much influence over the federal government. In 2021 alone, Big Pharma has spent nearly $263 million on lobbying — devoting three lobbyists to each member of Congress.

Americans Hold Overwhelming Negative Views Of The Pharmaceutical Industry. A 2019 Gallup poll found the pharmaceutical industry to be “the most poorly regarded industry in Americans’ eyes.” The critique of Big Pharma included their seemingly never ending price increases, massive lobbying influence, and role in the opioid crisis, proving distrust of the pharmaceutical industry is far reaching. 

Majority Of Americans Don’t Buy Pharma’s Argument. Nearly seven in 10 Americans are not convinced by the pharmaceutical industry’s argument that drug price negotiation will harm innovation. 

MEMORANDUM
TO: Interested Partners
FR: Protect Our Care
DT: November 5, 2021
MEMO: The Build Back Better Act Will Transform Health Care for Millions of Americans

The Build Back Better Act will be the most significant expansion of U.S. health care since the passage of the Affordable Care Act. The legislation includes historic measures to lower the cost of prescription drugs and insurance premiums, extend affordable coverage to millions, expand Medicare benefits to cover hearing, and invest $150 billion in home care for seniors and people with disabilities. By passing Build Back Better, Democrats are proving their commitment to building a future where health care is a right, not a privilege.

Polling shows the health care measures in Build Back Better have nearly universal support, and voters of all parties want bold action on health care. 

Under The Build Back Better Act: 

• 48 million Medicare Part D enrollees will have out of pocket costs for prescription drugs capped at $2,000 per year.
• 9 million Americans will save on their monthly health insurance premiums
• 2.2 million Americans currently in the Medicaid “coverage gap” will gain health coverage
• 62 million Americans on Medicare will gain coverage for hearing
• Medicare will have the power to negotiate for lower drug prices. By 2030, more than 100 drugs will be eligible for Medicare price negotiation, in addition to insulin products.
• ALL Americans will be protected from Big Pharma’s arbitrary price hikes that rise faster than inflation

Build Back Better Lowers Prescription Drug Prices

Giving Medicare The Power To Negotiate Lower Drug Prices. For nearly 20 years, Medicare has been banned from negotiating the price of prescription drugs, and Big Pharma has been able to dictate prices while Americans pay three times more for their medications than people in other countries. Under Build Back Better, Medicare will be empowered to negotiate prices for select drugs purchased at the pharmacy counter and administered at a doctor’s office. Beginning in 2025, 10 drugs, in addition to insulin, will be negotiated with that number increasing to 15 drugs in 2026, and 20 drugs in 2028 and into the future. By 2030, more than 100 drugs will be eligible for Medicare price negotiation, in addition to insulin products. Drug companies who refuse to come to the negotiating table will be subject to an excise tax.

Capping Out-Of-Pocket Spending For Seniors. Seniors with serious conditions like cancer, multiple sclerosis, and rheumatoid arthritis could save thousands of dollars on prescriptions under the Build Back Better Act. Medicare Part D out-of-pocket costs for prescription drugs will be capped at $2,000 per year beginning in 2024. The redesign of Medicare Part D will also allow out-of-pocket spending to be smoothed over the course of the year, so patients are not forced to pay the entirety of their out-of-pocket cost all at one time. 

Making Insulin Accessible And Affordable. Insulin co-pays for all Americans with insurance will also be capped at $35 each month. 

Putting An End To Outrageous Price Increases. Build Back Better stops Big Pharma from raising price increases faster than the rate of inflation. For example, Humira, a medication commonly used to treat rheumatoid arthritis, is one of the nation’s highest revenue generating drugs, raking in $21 billion in sales in 2019. AbbVie, Humira’s manufacturer, has hiked the price of Humira 27 times, including in January 2021 when it raised its cost by 7.4 percent. This cap would apply to all Americans, no matter whether you are insured or not, and no matter what kind of insurance you have, and is essential to stop arbitrary price increases on essential medications. Over the past 20 years, price increases for brand-name drugs in Medicare Part D have risen at more than twice the rate of inflation.

Build Back Better Lowers Health Insurance Premiums

Nine Million Americans Will Save On Monthly Premiums. Nine million Americans will save an average of $600 annually on their premiums when they buy insurance on their own through the ACA Marketplaces. For a family of four making $80,000 a year, premiums will drop nearly $250 a month, or nearly $3,000 a year. 

Expanding Health Coverage For Millions Of Americans. The Congressional Budget Office estimates that ACA enrollment would increase by 3.6 million people including 1.4 million who would otherwise be uninsured and 600,000 would have received unsubsidized coverage.

Reducing Income Coverage Disparities. Build Better Better ensures families above the 150 percent threshold pay no more than 8.5 percent of their income towards coverage. This will help middle-income families facing excessive premiums or living in high-premium areas. 

Expanding Coverage for Communities of Color. The Center on Budget Policy and Priorities estimates the increased savings continued under Build Back Better will cause a sharp decline in the uninsured rate across every racial group, with one in three uninsured Black adults gaining coverage. Prior to the American Rescue Plan, more than 11 million uninsured adults were eligible for premium tax credits, with people of color making up roughly half of the group.

Build Back Better Expands Medicaid

2.2 Million Americans Currently Denied Medicaid Will Gain Health Coverage. The Build Back Better Act will allow more than two million Americans currently trapped in the Medicaid coverage gap to access zero dollar premium health coverage. Of those currently in the coverage gap, 62 percent are in the labor force, 30 percent are parents with children at home, more than 25 percent are essential workers, and 15 percent of adults have a disability. 

Zero Dollar Premiums for Millions. In addition to covering the 2.2 million Americans in the Medicaid coverage gap, Build Back Better delivers zero dollar premium coverage to the 1.8 million uninsured individuals with incomes between $12,880 and $17,774 each year (100-138 percent of the federal poverty level). These plans 

Drastically Reducing Racial Health Disparities. Closing the Medicaid coverage gap is the single most important policy to expand coverage and reduce racial inequities in the American health care system. People of color are more likely to have a lower median income and live in a state without Medicaid expansion, compared with their white counterparts. In 2019, 60 percent of individuals in the coverage gap were people of color. 

Improving Coverage For Millions of Working Americans Whose Employer Coverage is Too Expensive Or Of Poor Quality. Millions of low-wage workers are offered employer health coverage that is cost prohibitive and not comprehensive. Over the past decade, premiums for low-wage workers have increased at nearly double the rate of wages. Build Back Better ensures that individuals who would be eligible if their state expanded Medicaid, can enroll in an ACA marketplace plan even if their employer offers coverage. This will allow low-wage workers to access comprehensive health coverage at little or no cost. 

Build Back Better Expands Medicare Benefits

Millions Will Gain Access To Hearing Care. Build Back Better would add hearing coverage to Medicare Part B starting in 2024. Kaiser Family Foundation estimates that a Medicare hearing benefit could aid all 62 million Medicare beneficiaries, particularly the 36 million purchasing coverage on their own or simply going without. Hearing coverage under Build Back Better would include hearing rehabilitation and treatment services, as well as hearing aids. Build Back Better would also allow audiologists and hearing aid specialists to qualify for Medicare reimbursement.

Addressing High Out-Of-Pocket Costs. In 2018, Medicare beneficiaries paid an average out-of-pocket cost of more than $900 for hearing care. Only 30 percent of seniors over 70 who need hearing aids are able to use them, with Kaiser Family Foundation citing affordability as the likely culprit millions do not seek hearing care or hearing devices. Build Back Better expand Medicare to include hearing coverage by providing $35 billion in funding for hearing care.

Build Back Better Will Dramatically Improve Maternal & Infant Health 

Providing 12 Months Of Continuous Coverage To Postpartum Women. In 2018, 45 percent of births were paid for by Medicaid, with 50 percent or more births covered by the program in 22 states. Medicaid covers 65 percent of all births to Black mothers. With Black maternal mortality rates 3.2 times higher than for white women, Build Back Better recognizes the expansion of Medicaid coverage to post-partum individuals is a pressing racial justice issue by providing 12 months of continuous coverage to postpartum women. 

Millions Invested To Address Social Determinants Of Health. The Black Maternal Health Momnibus Act provisions included in the Build Back Better Act contain $175 million to address social determinants of maternal health at the local level. This would include once-in-a-generation investments in housing, nutrition, and environmental conditions with the explicit focus of improving maternal health.

Funding Health Equity Measures. The Build Back Better Act includes $295 million to bolster and diversify the perinatal health workforce, including funding for midwives and doulas whose involvement is essential to reducing maternal deaths. An additional $100 million has been included for maternal mental health equity and $50 million for maternal health research at Minority-Serving Institutions.

Directly Confronting Systemic Racism in Maternal Care. $50 million for training to address racism, discrimiation, and bias — originally part of the Black Maternal Health Momnibus Act — is included in the Build Back Better Act. This training for health care professionals is just one of the many necessary steps required to begin addressing racism in the American health care system and improve maternal health equity. 

How Build Back Better Ensures Continuous CHIP Coverage

Keeping Children on Medicaid For A Full Year Who Abruptly Lose Coverage. The Build Back Better Act would require states to provide 12-month continuous coverage for children on Medicaid and CHIP. As of January 2020, 31 states provided continuous coverage. States that don’t provide continuous coverage experience increased churn, or children who dis-enrolled and re-enrolled in coverage within the same year. Continuous coverage would help reduce racial disparities as nearly 14 percent of Hispanic, 12 percent of Black, and 13 percent of children in low or moderate income households faced uninsurance for all or part of the year.

Build Back Better Expands Home And Community-Based Services

Build Back Better Will Allow Millions of Americans To Grow Old At Home. Medicaid is currently the largest provider of home and community-based care, providing essential services to seniors and people with disabilities. Build Back Better will provide an additional $150 billion for home and community-based services, that would provide care to the 2.5 million Americans already participating in the program, and help alleviate the current waitlist of more than 800,000 individuals. Federally provided home and community-based services funds helped more than 100,000 individuals return to their homes and communities from nursing facilities between 2008 and 2019, highlighting the enormous need for Build Back Better to strengthen this essential program.

Nearly 820,000 People On HCBS Waiting Lists Gain Assistance. In 2018, Medicaid waivers provided care for 2.5 million HCBS enrollees. As the aging population continues to grow, over three-quarters of states have HCBS waiver waiting lists. Individuals spend an average of 39 months on waiting lists prior to eligibility screening. The Build Back Better Act will provide HCBS funding to help the nearly 820,000 Americans on waiting lists.

HCBS Expansion Strengthens Direct Care Workforce. The direct care workforce is disproportionately composed of black, female, and lower-wage workers. In 2018, 58 percent of direct care workers earned less than $30,000 a year. Additionally, nearly one-third of workers live in a low-income family that makes less than 200 percent of the federal poverty line. 82 percent of the direct care workforce are women and one in four workers are Black. The Build Back Better Act will combat the HCBS workforce shortage that has been exacerbated by the Covid-19 pandemic and historically low wages.

Families Will Save An Estimated $5,800 In Home Care Costs. Older Americans and people with disabilities are often forced to liquidate their assets to afford as little as two years of in-home care. The HCBS provisions included in the Build Back Better Act will save families paying out-of-pocket an estimated $5,800 a year for four hours of care per week.