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WASHINGTON, DC – August 29, 2023 – Drug cost negotiation is one of the provisions in the Inflation Reduction Act of 2022 (IRA) that will make health care more affordable for seniors. On August 29^th, the federal government announced the first 10 drugs that the Centers for Medicare and Medicaid Services (CMS) will negotiate cost with pharmaceutical companies. The government aims to obtain the lowest maximum fair price to make drugs more affordable while allowing the drug companies to make a profit. Medicare beneficiaries will save on the cost of their most expensive prescription medicine. If Medicare spends less money on prescription drugs, then everyone benefits because drug coverage premiums will fall.

Some of the most widely prescribed or expensive medicines that older Americans use are on the list of 10. The IRA limits the selection criteria for the drugs that can be negotiated. Meena Seshamani, the deputy administrator for CMS said that, only drugs were selected that have been on the market for at least 7 years without a competing generic version and “biologic” drugs that have to administered by a physician must be on the market for at least 11 years. The drugs are: Eliquis & Xarelto (blood thinners), Jardiance & Januvia (for diabetes treatment), Farxiga (for the treatment of diabetes and heart failure), Entresto (for heart failure), Enbrel (for the treatment of autoimmune disease), Imbruvica (for the treatment of blood cancer) and Stelara (for psoriasis and other inflammatory disorders). The 10^th drug includes the insulin medicine Novolog and many of its related versions. The price changes will take effect in 2026. The Inflation Reduction Act allows 30 more medicines to be selected over the next 2 years for price changes to begin in 2027 for 15 drugs and 2028 for the remaining drugs.

The cost for these 10 drugs represented about 20% of the total spending for Medicare enrollees over the past year. The drugs cost over $50 billion for the year between June 1, 2022 through May 31, 2023. This does not include rebates and discounts that the drug companies may have set up after price negotiation with the private market. Medicare covered most of the cost; however, 9 million Medicare beneficiaries had to spend almost $3.5 billion in out-of-pocket costs.

America is the only developed nation in the world where a citizen can become financially-strapped because of the high cost of health care. Oftentimes, hard-working Americans have to compromise their health by spending their limited resources on food and shelter instead of prescription medicine. According to research from the Commonwealth Fund, about 9% of Medicare enrollees ages 65 and older said that in 2021 either they did not fill their prescription or they skipped taking a drug dose due to cost.

In addition to including legislation to fight the climate crisis, lowering energy costs, and creating good paying jobs, the IRA lowers the cost of prescription drugs and health care for Medicare recipients and for people in the Affordable Care Act (ACA) exchanges.

This is how the IRA lowers health care costs for Medicare recipients:

• Medicare will be able to negotiate prices of certain drugs with pharmaceutical companies
• Beginning this year, insulin co-payments will be capped at $35 a month
• Beginning in 2025, out-of-pocket costs for prescription medicines will be capped at $2,000 annually

Other health care savings include:

• Drug company rebates if prescription prices outpace inflation
• 3 more years of Marketplace subsidies by the federal government

Here are some health & financial impacts of the IRA:

• 4 million people will save on the cost of their prescription medicine, particularly expensive drugs for cancer or multiple sclerosis.
• 3 million Americans used insulin to treat diabetes in 2020 and many will save money
• 13 million Americans will avoid increasing Marketplace premiums for 3 years.

Drug companies and their allies have filed 8 lawsuits challenging the IRA provision forcing drug price negotiations in behalf of Medicare enrollees. Drug companies and some politicians argue that lower drug prices through negotiation will disincentivize drug research and reduce the number of new drugs that are brought to market.

In a statement on August 29^th by President Biden, “Millions of Americans are forced to choose between paying for medicines they need to live or paying for food, rent, and other basic necessities. Those days are ending.”

 

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Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

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ASHEVILLE, NC –  September 6, 2023 – The COVID-19 metrics are on the CDC’s COVID Dashboard.

• For the week ending on August 19^th, hospital admissions are at a low level in every county in North Carolina and more than 96% of the counties in the U.S. Buncombe County’s COVID-19 hospitalizations are low and have increased from the previous week.
• For the week ending on August 26^th, about 3% of the deaths in North Carolina last week were due to COVID, the 3^rd lowest level of 6 groups.
• Emergency room visits for COVID-19 are low in North Carolina for the week ending on August 26^th. This represents about 2% of all ER visits, the 2^nd lowest of 5 levels.

Wastewater monitoring can be used to provide early warning for COVID outbreaks. The Buncombe & Henderson counties wastewater data for the week ending on August 23^rd is on the North Carolina COVID Dashboard.

• The number of viral gene copies in each water sample is at a red level representing the highest level of 5 groups, currently between the 80^th and 100^th percentile relative to the past level measured at the same site.
• The 15-day rate of change of number of viral gene copies in each water sample is increasing from the previous week, at 100% or greater, the highest of the 3 groups for positive rate of change.

In summary, wastewater levels, emergency department visits, and deaths are up from the previous week.

The U.S. Department of Health and Human Services wants everyone to know that:

• COVID-19 can affect people differently. Some people have mild symptoms like a cold and others have more severe symptoms like a bad case of the flu. Some effects can be long-lasting.
• Older adults and immunocompromised people are at a higher risk of developing severe illness and being hospitalized. The CDC recommends that people in these groups get an updated COVID-19 bivalent booster because it gives added protection.

The Department of Health and Human Services recommends:

• Stay up-to-date with COVID-19 vaccines
• For extra protection, wear an efficient medical grade mask
• People who are positive for COVID-19 or do not feel well should stay home
• People with any COVID symptoms should get tested
• If you test positive, your doctor may recommend medical treatment

More and more Americans have developed some immunity to COVID-19 from immunizations and previous infection. New variants continue to infect people with the most at-risk groups more susceptible to severe illness.

 

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Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

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GERMANY – August 11, 2023 –  Does it make any difference if a series of vaccinations are in the same arm or different arms? According to a study from Germany that was recently published in eBioMedicine (a peer-reviewed journal from The Lancet Discovery Science series), the first vaccination of the 2-dose COVID-19 series can produce a strong immune response and the 2^nd shot induces a stronger response if it was in the same arm than if it was in the other arm. Therefore, this study supports having all vaccinations from the series in the same arm to achieve the highest protection against getting infected and severe disease.

More than 300 hundred immunocompetent persons without a history of COVID-19 were enrolled in this observational study. They were randomized so that about half had both COVID-19 shots in the same arm and the other half had them in different arms. The 2 groups were similar in age and sex distribution and with blood test evaluation between the number of white blood cells and its cells that fight infection and make antibodies to fight infection.

Some vaccine-sensitive diseases require more than one shot to achieve a good immunization response that is essential in fighting infections. Examples are COVID-19, rabies, tetanus and haemophilus influenza type b (h. flu.) diseases. Many people can’t remember which arm had the first shot. They may get the shots in their non-dominant arm to avoid soreness in their dominant arm.

The immune response after sequential vaccinations has been previously studied by injection site. There was one study of adults after a 4-dose rabies vaccination series and one British study for infants after a 3-dose h. flu regimen, a 3-dose tetanus regimen, and a 3-dose pneumococcal series. In the adult study, there was a higher immune response with injections to the same arm. In the study of children, there was no difference in site-specificity for the pneumococcal and tetanus cohort. In contrast, the h. flu group showed a higher immune response after the second injection in the different leg group than in the same leg.

The vaccine is administered in adults via injection into the deep part of the thick deltoid muscle which surrounds the shoulder. The vaccine is drained into the lymph nodes within the axillary region of the same side, at the junction between the upper arm and the chest wall. These lymph nodes become larger than the other side indicating a higher metabolic activity in response to the shot. Previous studies have shown that the white blood cells responsible for the immune response are stimulated after one vaccination and multiply after a second shot in the same arm. People who had injections into the same arms had a stronger immunogenic response after the subsequent shots than persons injected into different arms.

In contrast to adults, children are injected into the upper thigh region. In children, the upper thigh region does not drain into lymph nodes specific to the same side of the body. Each side merges in the pelvis. The children who had repeat shots on the same side did not have a stronger immune response than if they had their shots in different legs.

Choosing which arm to have the second or sequential vaccination has never been felt to be important. This study shows that adults have a higher immune response following a series of COVID-19 vaccinations if they are in the same arm. Having a higher immune response should be more effective in preventing COVID infection and severe disease. This may be very important for elderly and immunocompromised people who do not usually mount a strong immune response. Injections in the same arm may also be more protective against other vaccine-specific disease that requires more than one vaccination.

 

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Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, [email protected]

More Posts for Show: Asheville FM News Hour