Drug prices, affordability, VA mental health in Biden's fiery State of the Union address

Photo: Jacquelyn Martin/Pool/Getty Images

In a fiery State of the Union speech punctuated by heckling from some Republicans, president Joe Biden last night outlined what he plans to do to "finish the job" his administration started.

Biden, 80, has yet to announce whether he'll seek reelection in 2024.

Biden touted the strides his administration has made in healthcare, such as capping out-of-pocket insulin costs at $35 for Medicare beneficiaries through passage of the Inflation Reduction Act.

"But there are millions of other Americans who are not on Medicare, including 200,000 young people with Type I diabetes who need insulin to save their lives," Biden said. "Let's finish the job this time. Let's cap the cost of insulin at $35 a month for every American who needs it.

"This law also caps out-of-pocket drug costs for seniors on Medicare at a maximum $2,000 per year when there are in fact many drugs, like expensive cancer drugs, that can cost up to $10,000, $12,000 and $14,000 a year," he said. "If drug prices rise faster than inflation, drug companies will have to pay Medicare back the difference. And we're finally giving Medicare the power to negotiate drug prices. Bringing down prescription drug costs doesn't just save seniors money. It will cut the federal deficit, saving taxpayers hundreds of billions of dollars on the prescription drugs the government buys for Medicare. Why wouldn't we want to do that?"

The Campaign for Sustainable Rx Pricing applauded what it called the positive progress toward holding Big Pharma accountable and lowering prescription drug prices. 

"Policies that cap out-of-pocket costs must also address Big Pharma's egregious practices that cause these high prices," said CSRxP executive director Lauren Aronson.

However, Pharmaceutical Research and Manufacturers of America (PhRMA) president and CEO Stephen J. Ubl said, "The Inflation Reduction Act took steps to reduce out-of-pocket costs in Medicare. Unfortunately, it also put in place policies that are already impacting the research and development we need to achieve some of the goals President Biden laid out. The government price setting provisions in the law are forcing companies to make difficult choices, including shifting focus away from certain types of medicines and discouraging the research that takes place after medicines are first approved – threatening the very research that remains critical to improving outcomes for cancer and other diseases."

Capping the costs of insulin helps some patients, Ubl said, especially those who aren't benefiting from the average 84% discount insurers and their middlemen get for insulin, but it leaves behind many others. 

"It's a Band-Aid on a broken system that's forcing people to pay more for medicines than health insurers and pharmacy benefit managers pay," Ubl said.

Connected Health Initiative president Morgan Reed said CHI was pleased the president recognized the need for additional mental health resources, especially for veterans.

But Reed said CHI was disappointed the president did not take the opportunity in his speech to move forward a discussion on digital medicine.

"This was an opportunity to take lessons learned from the public health emergency on digital tools and offer some direction," Reed said Wednesday morning. "I was disappointed in the moment, but hopeful in the long run."

Continuing PHE initiatives in telehealth has bipartisan support, he said, despite last night's bipartisan bickering.

"Even throughout the screaming the president was saying he was supporting Medicare, and Marjorie Taylor Greene (R-Ga.) was supporting healthcare. Healthcare is an important pillar. I hope we get to some bipartisan agreement in spite of the shouting."

While telehealth waivers have gotten a two-year extension past the end of the public health emergency, other flexibilities will end on May 11 when the PHE ends.

"Before the end of the PHE, I'm hopeful we can get the administration to take some actions to get us some runway," Reed said. "I think Congress will have some limited action around specific items that will go away."

In a statement, CHI called on the administration and Congress to do more, particularly in the areas of health data privacy and in supporting digital health capabilities, particularly those enabled by public health emergency waivers and flexibilities.

Better Medicare Alliance urged the administration to protect Medicare by reconsidering proposed cuts to Medicare Advantage plans released last week by the Centers for Medicare and Medicaid Services 2024 Medicare Advantage Advance Notice.

Mary Beth Donahue, president and CEO of BMA said, "The administration's massive proposed cuts to Medicare Advantage would threaten the high-quality, affordable care that beneficiaries depend on."

United States of Care CEO and cofounder Natalie Davis said, "Despite all of this progress in 2022, the American healthcare system still has a very long way to go to ensure that everyone has access to affordable, dependable, and personalized care that they can understand."

Margaret A. Murray, CEO of the Association for Community Affiliated Plans, commented on Biden's proposal during his speech to make permanent the enhanced advance premium tax credit (APTC) subsidies for people with low incomes who purchase coverage through the ACA health insurance marketplaces. The enhanced subsidies were extended last year for three years.

"We're delighted that President Biden has proposed to make permanent the enhanced APTCs, which will squarely address the biggest problem with the American healthcare system: its unaffordability for workers with low incomes and their families," Murray said. "The enhancements extended by the Inflation Reduction Act were vital in keeping workers and families with low incomes from going uninsured owing to concerns around affordability. It's one of the prime reasons that the uninsurance rate is currently at an all-time low of 8% percent and a record-breaking 16.3 million consumers signed up for coverage during this year's open enrollment."  

Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health, attended the State of the Union.

""We appreciate the president's commitments to addressing healthcare disparities and calls to unite around key intersectional issues essential to our collective liberation such as gun control, voting rights, and reproductive rights. We continue to need bold action to protect and expand abortion access in this perilous moment beyond calls to codify Roe v. Wade – a floor that left many without access," Perritt said.

"As we deal with continued threats following the overturn of Roe v. Wade – including a lawsuit that could soon revoke the FDA's approval of mifepristone – now is the time for the Biden administration to expand on their commitment to ensuring real access to abortion care."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org