Financial Security, Lasting Relief: How the Inflation Reduction Act Restores Health to Patients and Hope to Their Doctors

I frequently have conversations with my patients in their early sixties who are planning for retirement – an important part of which is transitioning from commercial insurance to Medicare. When making this switch, a common concern for my older patients is ensuring they can still access their medications to manage their rheumatological conditions comfortably and affordably. 

Injectable biologic medications, like Enbrel, are a highly effective but expensive, life-changing treatment option for rheumatoid and psoriatic arthritis. However, many patients have often found these medications out of reach because of their high cost, and Medicare was not allowed to negotiate lower prices. This all changed in 2022 with the passage of the Inflation Reduction Act (IRA). This sweeping legislation ensures that patients no longer have to grapple with whether or not they can continue the therapies they need, nor do physicians have to consider second-best treatments for their patients, knowing the outcomes would be inferior.

In 2023, as part of the policies included in the IRA, Medicare selected ten high-cost drugs for the first round of negotiations for its new Drug Price Negotiation Program – including treatments for heart disease, autoimmune diseases, and cancer. These drugs accounted for $56.2 billion — 20% of Medicare Part D costs. I was thrilled to see that Enbrel, a vital arthritis medication, was included in the program as it aims to reduce the $3.9 billion in out-of-pocket costs shouldered by patients.

Medicare patients have long struggled to afford their treatments, and doctors have faced moral injury — the emotional distress that comes from knowing the care they’re providing is compromised due to factors beyond their control, like cost — while searching for less effective alternatives. The IRA has fundamentally changed that by finally allowing Medicare to negotiate drug prices, starting with ten high-cost medications, including Enbrel with plans to add more drugs yearly.

Patient improvement and well-being through biologics sustain me as a doctor and remind me why I entered this profession — to heal and enhance lives. When these life-changing treatments become less accessible, my job becomes less satisfying, contributing to widespread burnout and worsening the already concerning rheumatology workforce shortage. Instead of hearing about my patient’s grandkids, I have to pry as to why more joints are swollen than the visit prior. The lack of adherence isn’t always voluntary. And when patients admit costs are too high, we sit together: our anger, my empathy, and their shame. 

And it’s not just the arthritis patients. Medicare patients are also struggling to access their diabetes medications like Jardiance and blood thinners like Xarelto and Eliquis that prevent strokes. I would much rather listen to anecdotes about grandchildren and retirement center gossip, or give a pep talk about balance classes that could prevent a fall. 

Projections indicate that by 2030, the demand for rheumatologists will exceed supply by 138%, a troubling gap given the rapidly aging U.S. population. I’d like to think I will continue practicing for many more years, and legislation that helps doctors do their jobs will likely make me and my colleagues less likely to exit early from a profession we love, but unfortunately, that may not be the case.

Thankfully, the IRA is a large step in the right direction and will cap Medicare patients’ drug costs at $2,000 annually by 2026, with Enbrel discounted by nearly 70%. If these negotiated prices had been in place in 2023, Medicare would have saved $6 billion — a 22% reduction in drug costs. Those savings that are passed directly on to the patients. 

As part of the continued implementation of the IRA, the Centers for Medicare & Medicaid Services (CMS) will incorporate more patient and provider voices for the second round of negotiations to ensure Medicare beneficiaries have continued access to the therapies they need without putting a huge dent in their account. I’m impressed that CMS is listening to patient feedback, not just relying on data, when selecting drugs for Medicare’s drug price negotiation program. Just as doctors rely on patient input to provide the best care, democracy thrives when the government listens to the concerns of its voters. This balance is key to both effective healthcare and a responsive government.

The opposition to the IRA has been steady and well-funded. While the courts have thrown out lawsuits against the IRA from Big Pharma and the Chamber of Commerce, there is no indication that these forces will let up anytime soon. Rejecting the IRA purely on political grounds would be a great disservice to our seniors and the healthcare providers who care for them. For those who rely on these treatments, affordable medication access is a matter of health, freedom, and dignity, and their mechanisms and outcomes are non-partisan. Undermining this progress threatens the well-being of millions of Americans who have worked hard and deserve a secure, healthy retirement.

Photo: Stas_V, Getty Images

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