Watchdog Group Sounds Alarm on Health Insurers Not Lowering Prescription Costs for Seniors

The Coalition for Affordability and Prosperity (CAP) on Thursday sent a letter to Congress, sounding the alarm on health insurers not lowering prescription costs for seniors.

CAP Executive Director Chuck Flint sent a letter to the House Ways and Means Committee, House Energy and Commerce Committee, Senate Finance Committee, and Senate Health, Education, Labor, and Pensions (HELP Committee as the Trump administration continues to work on policies to make life more affordable for Americans.

The letter warns that many health insurers are not participating in a Centers for Medicare & Medicaid Services (CMS) pilot program that is “designed to extend lives and lower drug costs for working Americans.”

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CAP explained to lawmakers that the Trump administration negotiated directly with Eli Lilly and Novo Nordisk to secure a $245 net monthly price for BALANCE Model participants and set up a voluntary program for insurers to cover the cost of GLP-1 medications such as Wegovy and Ozempic. The voluntary program would make these medications accessible to Part D beneficiaries for the first time.

The Coalition for Affordability and Prosperity wrote, “The FDA has been unequivocal: these drugs save lives. They reduce heart attacks. They reduce strokes. They improve quality of life. For a senior living on a fixed income, access to a GLP-1 is a lifeline. The BALANCE Model delivers that lifeline. But only if insurers agreed to participate.”

CAP Insurer Letter by jmanship

The letter continued:

A majority of insurers, however, refused, and CMS announced on April 21 that it would not implement the BALANCE Model in Medicare Part D as planned in 2027. Seniors who were counting on it were left without the coverage and cost protections the program promised. The administration is now funding a bridge program to keep coverage in place, but the lifeline is thinner for millions of Part D beneficiaries and the cost to taxpayers because insurers chose to leave them behind.

Medicare patients who could have benefited from these drugs, for weight loss and for the cardiovascular and metabolic conditions GLP-1s help prevent, will enjoy a lower quality of life
and have their time cut short. The Medicare system was designed to prevent exactly this type of outcome for our seniors.

Republicans across Washington, DC, have criticized insurers for lobbying for more subsidies, bankrolling Democrats, and pushing woke discriminatory policies.

A senior Trump administration official told Breitbart News, “These health insurance companies are insanely woke. They engage in DEI discrimination in hiring and supplier contracting, and they even require providers to engage in discrimination in the name of ‘healthy equity.’”

The official added, “Instead of demanding that Congress give them more money to line their pockets by threatening to jack up rates on consumers, they should be more worried about DOJ and EEOC looking into some of their illegal conduct.”

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A Republican strategist told Breitbart News, “Every Republican on the Hill knows the major insurers worked with Democrats to force the Schumer shutdown over extending Obamacare subsidies with more taxpayer money. It’s the same cycle every time: insurers bankroll Democrats, lobby for bigger subsidies, then demand taxpayers cover the bill. The Coalition is right to call out insurers for taking billions from taxpayers while refusing to work with the Administration to lower costs.”

The CAP letter noted that federal programs account for an “enormous and growing share for insurer revenue,” adding that the federal government experienced the longest government shutdown in U.S. history over if Congress would continue to fund enhanced Obamacare marketplace subsidies, more formally known as the Enhanced Premium Tax Credit (EPTC).

CAP encouraged these committees to ask:

• Why should the federal government continue to subsidize insurers when they refuse to cover drugs, like GLP-1s, that have so many proven health benefits?
• How should participation, or refusal to participate, in voluntary cost-saving programs factor into decisions about future federal contracts and subsidies?

He concluded in the letter, “Working Americans deserve a health care system where every stakeholder, including the insurers that federal taxpayers help keep profitable, shows up when there is a chance to improve healthcare outcomes for seniors.”