Biden policies move needle on lowering drug pricing, but more needs to be done to fulfill promise

Much has happened since President Joe Biden, then a candidate, made a campaign-trail pledge to lower drug costs. He said in a Nov. 2, 2020, speech that he would "lower prescription drugs by 60%, and that's the truth."

He followed up on that promise early in his term, with a July 2021 executive order that gave a road map of how his administration planned to do it. At the time, drug pricing experts said these actions might help, but they warned that legislation was necessary to move closer to keeping that campaign promise.

Then, last summer, following a long partisan fight, Congress adopted wide-ranging legislation called the Inflation Reduction Act, part of which targeted prescription drug costs. It passed with no Republican votes. Biden signed it into law Aug. 16. But has any of this moved the needle toward Biden's promise?

Experts say the new policies could move closer to the 60% mark, but with caveats.

Through this law, "there are people who are going to save thousands, either because they are taking many drugs or certain high-cost drugs," said Matthew Fiedler, senior fellow at the USC-Brookings Schaeffer Initiative for Health Policy. Unless the law is repealed, "those reductions in prices will eventually happen."

But the big picture is murkier, he and other experts said.

It isn't clear, for example, whether the 60% reduction Biden promised was aimed at drug costs for individuals, lower prices across many drugs, or a spending drop of that size in the overall national prescription drug tab.

If Biden was aiming for a 60% reduction in the cost of drugs across the U.S., then the inflation reduction measure "is not going to meet that target," Fiedler said. "This is a big change in government policy. But it's not a 60% change."

What else does the law do?

Its drug provisions are varied. One, which went into effect in October, increases payment incentives for physicians to prescribe what are called biosimilars, which are lower-cost alternatives to expensive brand-name biologic drugs. And, as of January, Medicare enrollees' insulin prices are capped at $35 a month.

But what's gotten much more attention are the changes to Medicare. In addition to the insulin cap, the law allows Medicare for the first time to negotiate prices with drug manufacturers. It starts small — with 10 drugs that don't have generic or biosimilar competitors — in 2026. More will be added to the list each year. No one knows yet which drugs' prices will be the first to be negotiated, though they must be selected from among the 50 drugs with the highest Medicare spending.

"It starts slow, but it does accumulate fairly rapidly," said Benedic Ippolito, a senior fellow in economic policy studies at the American Enterprise Institute.

Those provisions are estimated to save $98.5 billion over 10 years for Medicare, according to the Congressional Budget Office.

A provision that goes into effect this year requires drugmakers to rebate Medicare if their prices rise faster than inflation, with an estimated government savings over 10 years of $63.2 billion.

Another change affects how much Medicare enrollees must pay out-of-pocket annually toward their drugs. Those changes start to take effect in 2024 — and let's just describe them as complex. Bottom line: Medicare beneficiaries who use a lot of drugs or very expensive drugs will see their share of the costs lowered and capped, to $2,000 a year by 2025, and rising after that by a specific index.

KFF estimated 1.4 million Medicare members enrolled in Part D of the program had out-of-pocket drug costs that exceeded $2,000 in 2020, averaging about $3,355 each. Likely more will benefit from the provision by the time it goes into effect, the September report noted. (Kaiser Health News is an editorially independent program of KFF.)

Unlike some other provisions in the Inflation Reduction Act, the CBO estimated that the Medicare out-of-pocket-cap will cost the federal government — about $30 billion over 10 years.

A few other provisions also affect drug costs and access. All told, the CBO said, the legislation will reduce the federal deficit by $237 billion over 10 years.

So how to rate Biden's promise?

"Congress passed a law, and the president signed that piece of legislation, which will significantly lower prices of some drugs for some people in the future," said Ippolito.

But it isn't just what people pay as their share of the cost of some drugs, he emphasized. Biden seemed to promise a 60% reduction, but whether that is for some individuals, the prices manufacturers set in the first place, or total national spending on drugs is unclear.

"One of the specific things about Biden's statement was the 60% reduction, and we don't know if that's going to be the case or for how many drugs because we don't know how the agencies will implement the law," Ippolito said.

That's one reason he considers the promise as "a work in progress." It's also uncertain just how Medicare will set the maximum prices allowed in the program for those drugs that will be selected for the effort.

Fiedler, however, thought Biden's promise was partly achieved,  in that significant changes have been accomplished that will substantially lessen costs for some people or for some prescriptions, but fall short of a 60% reduction when the number is applied across the pharmaceutical marketplace.

"Has the administration taken big steps on prescription drugs that will substantially reduce prices? The answer is yes," said Fielder. But he also said it would take time before "these price reductions fully materialize" and there is "a meaningful reduction in what the U.S. pays for drugs."

Some provisions are just now taking effect, and the groundwork is set for more.

Savings will start to be seen by some Americans this year under the insulin out-of-pocket cap and potentially through the incentives for doctors to prescribe lower-cost biosimilars. Several big-ticket items — the out-of-pocket spending cap for enrollees in Medicare, and the drug price negotiations — will play out over the next three years. Those changes may lead to consumers and the federal treasury saving hundreds of billions of dollars over the next decade.

Still, because it will take time to see how these reductions come to fruition, and whether they reach a 60% mark, our rating on the promise remains In the Works.