Mississippi Today

Five things to know about the new drug pricing negotiations

Published

1 year ago

August 30, 2023

The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ever-rising drug prices for seniors and, eventually, other Americans.

Under the 2022 Inflation Reduction Act, Congress gave the federal government the power to negotiate prices for certain high-cost drugs under Medicare. The list of drugs selected by the Centers for Medicare & Medicaid Services will grow over time.

The first eligible drugs treat diabetes, blood clots, blood cancers, arthritis, and heart disease — and accounted for about $50 billion in spending from June 2022 to May 2023.

The United States is clearly an outlier on drug costs, with drugmakers charging Americans many times more than residents of other countries “simply because they could,” Biden said Tuesday at the White House. “I think it’s outrageous. That’s why these negotiations matter.”

He added, “We’re going to keep standing up to Big Pharma and we’re not going to back down.”

Democratic lawmakers cheered the announcement, and the pharmaceutical industry, which has filed a raft of lawsuits against the law, condemned it.

The companies have until Oct. 2 to present data on their drugs to CMS, which will make initial price offers in February, setting off negotiations set to end next August. The prices would go into effect in January 2026.

Here are five things to know about the impact:

1. How important is this step?

Medicare has long been in control of the prices for its services, setting physician payments and hospital payments for about 65 million Medicare beneficiaries. But it was previously prohibited from involvement in pricing prescription drugs, which it started covering in 2006.

Until now the drug industry has successfully fought off price negotiations with Washington, although in most of the rest of the world governments set prices for medicines. While the first 10 drugs selected for negotiations are used by a minority of patients — 9 million — CMS plans by 2029 to have negotiated prices for 50 drugs on the market.

“There’s a symbolic impact, but also Medicare spent $50 billion on these 10 drugs in a 12-month period. That’s a lot of money,” said Juliette Cubanski, deputy director of KFF’s analysis of Medicare policy.

The long-term consequences of the new policy are unknown, said Alice Chen, vice dean for research at University of Southern California’s Sol Price School of Public Policy. The drug industry says the negotiations are essentially price controls that will stifle drug development, but the Congressional Budget Office estimated only a few drugs would not be developed each year as a result of the policy.

Biden administration officials say reining in drug prices is key to slowing the skyrocketing costs of U.S. health care.

2. How will the negotiations affect Medicare patients?

In some cases, patients may save a lot of money, but the main thrust of Medicare price negotiation policy is to provide savings to the Medicare program — and taxpayers — by lowering its overall costs.

The drugs selected by CMS range from specialized, hyper-expensive drugs like the cancer pill Imbruvica (used by about 26,000 patients in 2021 at an annual price of $121,000 per patient) to extremely common medications such as Eliquis (a blood thinner for which Medicare paid about $4,000 each for 3.1 million patients).

While the negotiations could help patients whose Medicare drug plans require them to make large copayments for drugs, the relief for patients will come from another segment of the Inflation Reduction Act that caps drug spending by Medicare recipients at $2,000 per year starting in 2025.

3. What do the Medicare price negotiations mean for those not on Medicare?

One theory is that reducing the prices drug companies can charge in Medicare will lead them to increase prices for the privately insured.

But that would be true only if companies aren’t already pricing their drugs as high as the private market will bear, said Tricia Neuman, executive director of KFF’s program on Medicare policy.

Another theory is that Medicare price negotiations will equip private health plans to drive a harder bargain. David Mitchell, president of the advocacy group Patients for Affordable Drugs, predicted that disclosure of negotiated Medicare prices “will embolden and arm private sector negotiators to seek that lower price for those they cover.”

Stacie B. Dusetzina, a professor of health policy at Vanderbilt University, said the effect on pricing outside Medicare isn’t clear.

“I’d hedge my bet that it doesn’t change,” she said.

Nonetheless, Dusetzina described one way it could: Because the government will be selecting drugs for Medicare negotiations based partly on the listed gross prices for the drugs — distinct from the net cost after rebates are taken into account — the process could give drug companies an incentive to lower the list prices and narrow the gap between gross and net. That could benefit people outside Medicare whose out-of-pocket payments are pegged to the list prices, she said.

4. What are drug companies doing to stop this?

Even though negotiated prices won’t take effect until 2026, drug companies haven’t wasted time turning to the courts to try to stop the new program in its tracks.

At least six drug companies have filed lawsuits to halt the Medicare drug negotiation program, as have the U.S. Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America, known as PhRMA.

The lawsuits include a variety of legal arguments. Merck & Co., Johnson & Johnson, and Bristol Myers Squibb are among the companies arguing their First Amendment rights are being violated because the program would force them to make statements on negotiated prices they believe are untrue. Lawsuits also say the program unconstitutionally coerces drugmakers into selling their products at inadequate prices.

“It is akin to the Government taking your car on terms that you would never voluntarily accept and threatening to also take your house if you do not ‘agree’ that the taking was ‘fair,’” Janssen, part of Johnson & Johnson, wrote in its lawsuit.

Nicholas Bagley, a law professor at the University of Michigan, predicted the lawsuits would fail because Medicare is a voluntary program for drug companies, and those wishing to participate must abide by its rules.

5. What if a drug suddenly gets cheaper by 2026?

In theory, it could happen. Under guidelines CMS issued this year, the agency will cancel or adjourn negotiations on any drug on its list if a cheaper copycat version enters the market and finds substantial buyers.

According to company statements this year, two biosimilar versions of Stelara, a Johnson & Johnson drug on the list, are prepared to launch in early 2025. If they succeed, it would presumably scotch CMS’ plan to demand a lower price for Stelara.

Other drugs on the list have managed to maintain exclusive rights for decades. For example, Enbrel, which the FDA first approved in 1998 and cost Medicare $1.5 billion in 2021, will not face competition until 2029 at the earliest.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Jerry Mitchell: Why Medgar Evers should represent Mississippi in U.S. Capitol Statuary Hall

Published

8 mins ago

September 20, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-09-20 11:32:07

Jerry Mitchell: Why Medgar Evers should represent Mississippi in U.S. Capitol Statuary Hall

Editor’s note: Mississippi Today and the Mississippi Humanities Council cosponsored an event – “Reimagining Statuary Hall” – on Sept. 18 at The Station in Fondren. Several speakers suggested accomplished Mississippians to represent the state in Statuary Hall at the U.S. Capitol. Currently, statues of staunch segregationists Jefferson Davis and J..Z. George represent Mississippi. What follows is Mississippi Today investigative reporter Jerry Mitchell’s pitch from the event.

Medgar Evers Credit: National Park Service

Medgar Evers dove onto the sand at Normandy. In the weeks following the D-Day invasion of June 6, 1944. He joined a million soldiers fighting to expand the beachhead. The Luftwaffe strafed and bombed them, hoping to push them back into the sea.

He was also part of the Red Ball Express, which provided fuel, food and other critical supplies as Allied troops pushed back the German forces.

As Allied forces freed more of France from Nazi occupation, Evers enjoyed life without the color line. He could eat in any restaurant he desired. He even fell in love with a French girl.

After battling the Nazis, he returned to Mississippi and fought racism all over again in the form of Jim Crow, which barred Black Americans from restaurants, restrooms and voting booths. When he tried to vote in his hometown of Decatur, Mississippi, he and other Black war veterans were turned away by an armed white mob.

After graduating from Alcorn College, he worked for his mentor, Dr. T.R.M. Howard, and was involved in passing out bumper stickers across the Delta that read, “Don’t Buy Gas Where You Can’t Use the Restroom.”

In January 1954, he tried to enroll at the University of Mississippi School of Law — only to be turned away. NAACP officials considered taking up his case but were so impressed with him they decided instead to hire him as the first field secretary for the Mississippi NAACP.

He investigated violence against African Americans, including the 1955 assassinations of the Rev. George Lee and Lamar Smith, who were killed because they helped Black Mississippians register to vote.

He worked with Dr. Howard on the lynching of Emmett Till and helped find new witnesses.

The economic threats and violence became so great that Dr. Howard and others left Mississippi, but Medgar Evers stayed.

He helped James Meredith enroll at Ole Miss, and he logged 40,000 miles a year traveling the roads, sometimes flooring it past 100 to escape those hell-bent on harming him.

His telephone rang at all hours with threats. Some were short and emphatic: “We’re going to kill you, N-word.” Others described how they planned to torture him.

Evers told a CBS reporter, “They say I’m going to be dead soon, that they’re going to blow up my house, that they’re going to blow my head off. If I die, it will be a good cause. I’m fighting for America just as much as the soldiers in Vietnam.”

After the white mayor of Jackson chastised the civil rights movement in Mississippi in spring 1963, Evers won his FCC bid for “equal time” to respond. He talked on television about the mistreatment of Black Mississippians and in so doing he became even more of a target. The Evers’ home was firebombed.

Hours after President Kennedy told the nation that the grandchildren of those enslaved are “not yet freed from the bonds of injustice,” Evers was shot in the back as he stepped onto his own driveway in Jackson, Mississippi. His wife, Myrlie Evers, heard the shot, ran outside, saw the blood and screamed. When the children heard the scream, they ran outside and saw their father.

“Daddy, get up,” his 8-year-old daughter, Reena, said. “Daddy, get up.”

He never did.

On Evers’ birthday in 1964, Congress passed the Civil Rights Act

Three decades later, his family finally saw his assassin convicted.

“All I want to say is, ‘Yay, Medgar, yay!’” Myrlie Evers declared as she wiped away tears. “My God, I don’t have to say accused assassin anymore. … what he failed to realize was that Medgar was still alive in spirit and through each and every one of us who wanted to see justice done.”

That justice inspired others. To date, 24 men have been convicted in civil rights cold cases.

A year after Evers’ killer went to prison, Myrlie Evers became chairman of the national NAACP and helped rescue the civil rights organization from the brink of bankruptcy.

She continues to break boundaries. She became the first lay person to deliver the inaugural invocation at Barack Obama’s second inauguration.

She cheered when Mississippi removed the Confederate emblem from the state flag, and she told me the reason we keep repeating its history is we don’t know our history.

Putting Medgar Evers in Statuary Hall would honor a fallen soldier in the war against hate and would help ensure that we know our history so that we don’t repeat it.

Jerry Mitchell on his Statuary Hall pick; Medgar Evers

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Rick Cleveland: Why Walter Payton should represent Mississippi in U.S. Capitol Statuary Hall

Published

1 hour ago

September 20, 2024

Staff Editor

mississippitoday.org – Rick Cleveland – 2024-09-20 11:31:58

Rick Cleveland: Why Walter Payton should represent Mississippi in U.S. Capitol Statuary Hall

Editor’s note: Mississippi Today and the Mississippi Humanities Council cosponsored an event – “Reimagining Statuary Hall” – on Sept. 18 at The Station in Fondren. Several speakers suggested accomplished Mississippians to represent the state in Statuary Hall at the U.S. Capitol. Currently, statues of staunch segregationists Jefferson Davis and J..Z. George represent Mississippi. What follows is Mississippi Today sports columnist Rick Cleveland’s pitch from the event.

Walter Payton, running back for the Chicago Bears, is pictured in 1986. (AP Photo)

I have spent a lifetime writing about football, primarily Mississippi football. I have watched and written about many of the greatest football players to ever play the sport. And I am here to tell you Walter Payton of Columbia and Jackson State is easily the greatest all-around football player I have ever seen or ever hope to see.

You don’t have to take it from me. The National Football League is the most popular and easily the most successful sports organization on Earth. Since the league began, tens of thousands have played and coached. And here’s the deal: The most cherished award the NFL gives is known as the Walter Payton Man of the Year Award, which recognizes excellence both on and off the field. At first, the award was known just as the NFL Man of the Year. Payton himself won it in 1977. Shortly after Walter’s untimely death in 1999, the league renamed the trophy as a tribute to Walter’s incredible work ethic, his football greatness and his legacy as a giver, a humanitarian.

Now then, choosing just two people to represent Mississippi in the National Statuary Hall Collection is an incredibly difficult task. That said we can do a whole lot better than we have. Mississippi has the highest percentage of Black population in the United States. To have two Confederate leaders, champions of slavery, representing us in the U.S. Capitol is nothing short of appalling. Mississippi’s two statues should be of people who represent what we do best. They should represent the best of Mississippi, not the worst. We do many things exceedingly well, including writing books, making music and playing sports.

You could argue — and I will — that we excel at nothing more than we do football. Mississippi has produced more NFL players per capita than any other state. And it’s not just quantity; it’s quality. We have produced more Pro Football Hall of Famers per capita than any other state, as well.

Our football heroes, Black and White, have emerged mostly from small towns. Walter Jerry Payton, nicknamed “Sweetness,” grew up in Columbia and came along at the cusp of integration. Walter was part of the first integrated football team at Columbia High School. In many ways, Columbia was a microcosm of Mississippi society as it pertains to integration: Black kids and White kids were playing organized sports together for the first time, working together, sweating together as teammates and being all the better for it. The late Maurice Dantin, a political leader and a candidate for governor, was a lineman on that first integrated team. He was, as he put it, one of seven White guys, blocking for four Black guys. Maurice told me: “The first time I saw Walter I was like everybody else. I was astounded. He did things on the football field I could never have imagined. Off the field, he was a good guy, a regular guy, a great teammate.” The two, Payton and Dantin, were friends for life.

That happened in small towns across Mississippi. Sports, football especially, showed the way. We were better for it. It says something about Mississippi a little more than half a century ago that Ole Miss, Mississippi State and Southern Miss, the three major football colleges in the state, did not recruit such a remarkable talent. I was a neophyte sports writer in Hattiesburg at the time. We had a Columbia correspondent, an elderly woman named Eva B. Beets, who called in the Columbia results every Friday night. I’ll never forget her rich, melodious Southern voice. “Rickey,” she’d drawl, “you are not going to believe what that Payton young’un did tonight…” In his last high school game, Walter scored six touchdowns, and on the last one he ran the last 35 yards backwards. Nobody could catch him.

Well that was it for the coaches at historically white universities. They weren’t about to have their first Black football player be a showboat drawing attention to himself. It remains singularly the dumbest thing I have ever heard. You can teach a player how to run forward and then hand the ball to the referee after scoring a touchdown; you can’t teach him how to score six touchdowns. Walter led the nation in scoring and set an NCAA scoring record at Jackson State. With the Chicago Bears, he scored a remarkable 125 touchdowns and handed the ball to the official after nearly every one.

Walter became the NFL’s all-time leading rusher, but he also excelled as a blocker, a receiver, a passer, a kick returner and even as a punter and kicker. He would have been a helluva strong safety, too. I once asked the great linebacker D.D. Lewis of Mississippi State and the Dallas Cowboys who was the hardest guy he ever had to tackle. D.D. didn’t hesitate. “Walter Payton, by far,” he answered. “It hurt. I mean, it really hurt. Trying to tackle Walter was like trying to tackle a 215-pound bowling ball.”

D.D., as any player who played with or against Walter, had the utmost respect for No. 34. Walter Payton was the epitome of what any athlete should strive for: Uncommon ability, superhuman work ethic, beloved teammate.

I’ll be honest with you. I don’t know who Mississippi’s two statues in the U.S. Capitol should be. I do know there are so many great choices other than what we have. And I believe Walter Payton, the greatest to ever do what Mississippians do best, should be strongly considered.

Rick Cleveland on his Statuary Hall pick; Walter Payton

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1958

Published

7 hours ago

September 20, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-09-20 07:00:00

Sept. 20, 1958

Dr. Emil Naclerio, a member of the surgical team that operated on Martin Luther King Jr., at his bedside in Harlem Hospital. AP File photo Credit: Front page of the New York Daily News, Sept. 21, 1958.

Martin Luther King Jr. was stabbed in New York City.

King was signing his first book, his account of the Montgomery Bus Boycott, “Stride Toward Freedom,” when a well-dressed woman shouted, “Is this Martin Luther King?” King, then 29, answered, “Yes, it is.”

The woman, Izola Curry, who was later diagnosed as suffering from schizophrenia, walked up and stabbed him with a 7-inch knife. Patrolman Al Howard kept a bystander from removing the blade, which might have killed him.

“X-rays revealed that the tip of the blade was on the edge of my aorta, the main artery,” King later recalled. “Once that’s punctured, you’ve drowned in your own blood.” Surgeons operating on the civil rights leader said, “Had Dr. King sneezed or coughed, the weapon would have penetrated the aorta.… He was just a sneeze away from death.”

King was rushed to the Harlem Hospital, where one surgeon arrived in a tuxedo because he had been summoned from a wedding. During the four-hour surgery, King had two ribs and part of his breast plate removed. He was quick to forgive his would-be assassin, who was the Black daughter of sharecroppers.

“A climate of hatred and bitterness so permeates areas of our nation that inevitably deeds of extreme violence must erupt,” he told reporters. “The experience of these last few days has deepened my faith in the relevance of the spirit of nonviolence, if necessary social change is peacefully to take place.”

In his last sermon before his assassination, King recalled a letter he received then from a ninth-grade student, who happened to be white: “I read that if you had sneezed, you would have died. And I’m simply writing you to say that I’m so happy that you didn’t sneeze.”

The crowd stood and applauded. “I want to say tonight that I, too, am happy that I didn’t sneeze,” King continued. “Because if I had sneezed, I wouldn’t have been around here in 1960, when students all over the South started sitting in at lunch counters. … If I had sneezed, I wouldn’t have been down in Selma, Alabama, to see the great movement there. If I had sneezed, I wouldn’t have been in Memphis to see a community rally around those brothers and sisters who are suffering. I’m so happy that I didn’t sneeze.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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