Dr Mark Fendrick on Ways Congress Could Build on IRA Efforts to Cut Patient Costs

The Inflation Reduction Act (IRA) temporarily extended Affordable Care Act (ACA) premium subsidies and instituted an insulin co-pay cap for Medicare beneficiaries, but bipartisan agreement is needed to make these changes permanent and more broadly applicable, explained A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care^® and director of the Center for Value-Based Insurance Design at the University of Michigan.

Transcript

The IRA extended ACA premium subsidies another 3 years. Do you think subsidies may continue to be extended?

Well, you'd like to think that making insurance coverage more affordable would be popular and not partisan. But unfortunately, just about everything in the United States—from baseball to space exploration—has turned out to be partisan, in addition to health care. So, while it's certainly better than not extending these subsidies, to extend them for 3 years, it wouldn't surprise me to have this issue come to fore quite quickly, and it wouldn't surprise most of the listeners to understand that one party will support strengthening the Affordable Care Act and continuing its legacy and others may not be as interested.

The IRA was a pared-down version of the Build Back Better Act, which had several proposals to reform the ACA. Do you see a future life for any of those that did not make it into the IRA?

One of the more important proposals, and one that fell just 3 Republican senators’ votes short, was the application of an insulin co-pay cap of $35 a month in the commercial marketplace. We're very pleased and excited to know that this same policy was passed as part of the Medicare program. So now, people who require insulin will not have to pay exorbitant amounts of money out of pocket to get this potentially lifesaving drug.

It has been stated by Majority Leader [Chuck] Schumer [D-New York] that there will be a return to vote on the insulin co-pay cap in the commercial marketplace after the midterm elections. And I'm hopeful that Congress will act prudently and wisely and pass this extremely important policy that will impact people to use a potentially lifesaving drug for which, in my opinion, there is really no overuse.