The coronavirus has been ravaging the nation for more than eight months and Americans are just as vulnerable as ever. Millions are without work in the worst economy in decades. Millions more are struggling to make rent, buy groceries for their families and afford the medicines they need.
Addressing these plights should be top of mind for our nation’s leaders. That’s precisely why two rule changes the Trump administration is proposing for Medicaid — the program that provides health insurance to low-income Americans — are so unsettling.
As president of the National Hispanic Council on Aging, I have seen first-hand the devastating effects of chronic disease and COVID-19 in our communities. If these rule changes take effect, the result will be a rapidly worsening public health crisis.
One proposal would alter the way Medicaid handles the coupons drug makers issue to patients to reduce the price of their brand-name treatments. Many Americans — especially now, amid the pandemic — can afford their medicines only because of these coupons.
Typically, Medicaid enrollees have to meet a set deductible before the program begins paying for their care. Medicaid currently counts the value of these coupons toward the patient deductible.
That’s the right thing to do: the whole point of coupons is to lower the cost to patients, and that’s what counting them toward the deductible does.
Just as a $1 manufacturer coupon for breakfast cereal reduces the customer’s bill at the grocery-store checkout by $1, so should a drug manufacturer’s coupon reduce the patient’s cost — in this case, the deductible.
Under the new proposal, that would change. The instant effect of no longer requiring coupons to count toward the deductible would be to increase the pharmacy bill for Americans who are least able to afford it. That could leave patients in the lurch for thousands of dollars in unexpected costs.
The absence of this lifeline would prove especially damaging in Hispanic communities.
Almost a quarter of the people in the United States diagnosed with HIV are Hispanic, for example, and Hispanic patients face disproportionately severe complications from viral hepatitis. Diabetes is also more prevalent among Hispanics than among white Americans.
All these conditions require rigorous adherence to a prescription drug regimen to keep the condition of patients stable.
Yet nationwide, a quarter of diabetics report rationing insulin because of high drug prices. Making drugs more expensive by changing the coupon rules will only exacerbate the problem, with potentially fatal consequences.
A second new Medicaid rule would exact a terrible toll on the medical innovation patients rely on.
The proposal would broaden the definition of a category of medications called “line-extension” drugs — new medications that make only slight modifications to existing compounds. Medicaid pays less to manufacturers for drugs in this category than for new medications.
The proposed change would adopt a much looser definition of line-extension to include many combination drugs — those that take multiple existing treatments and combine them into a single pill.
These combination medications make it much easier for patients to adhere to a prescription regimen — one pill a day rather than multiple pills at various times during the day.
Unfortunately, this proposal would wipe out the incentives required to research, create and test these vital combination drugs. If pharmaceutical companies do not believe they can recoup the money spent developing new combination medications, they won’t invest in future projects. That’s what’s in store if this change takes effect.
Our leaders should be doing everything in their power to help patients, especially those from disadvantaged groups, obtain access to life-saving treatments.
Our communities can ill afford increased prices and a reduced chance that better treatments will reach them.