Access and Coverage

Innovations, Treatments, and Therapies

Pharmaceuticals are a key part of the treatment plan for many eye diseases (including rare diseases that cause vision loss). Federal policy has a number of powerful mechanisms that ensure ongoing availability, affordability, and accessibility for patients and promote a continuum from research to innovation to market acquisition and patient access. Such policies include federal investments in biomedical research, regulations that ensure safety and efficacy, and affordable coverage through patient assistance programs in public and commercial insurance plans.

As an organization that represents patients, Prevent Blindness believes that treatment decisions should be made between the patient and their eye care provider, and treatment options must be accessible, affordable, and safe for patients. While drug access and reimbursement systems are complex and built on an underlying system that is equally complex and difficult to navigate, patients should also bear some accountability when it comes to managing their health and adhering to their treatment. As such, health literacy and transparency in costs and patient responsibility are essential components of a system of care that is accessible, affordable, and manageable for patients.

Accordingly, policies must strive to ensure patients are well-informed consumers and promote patient decision-making. The total cost of care and aggregate impact on all patients, families, payers, and caregivers should also remain at the center of the conversation to ensure the burden doesn’t fall disproportionately on one entity within the system, including patients and families. Prevent Blindness joins many groups advocating for a number of these policies to balance the role of patients, providers, manufacturers, and researchers in the innovation and treatments ecosystem.

Inflation Reduction Act of 2022

The Inflation Reduction Act of 2022 (IRA) is landmark legislation in that, for the first time ever, it gives the federal government the authority to negotiate prices for a select group of high-cost drugs under both Medicare Part B and D. In addition, among its many provisions, the legislation would cap out-of-pocket spending on prescription drugs for Medicare Part D enrollees at $3,250 starting in 2024 and $2,000 in 2025 (which means beneficiaries will save substantially on their costs for high-priced specialty drugs) and limit monthly cost-sharing on insulin under Part D to $35.

The IRA is based heavily on drug prices, program spending, and market implications; therefore, it is difficult to determine at this point how effective the legislation will be in lowering drug prices for patients while also protecting their access to treatments. It is also unclear how patients will actually benefit from the IRA’s cost-saving provisions. Currently, the law is being implemented by the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services (HHS) with negotiated prices for selected Part D drugs set to take effect in 2026 and 2028 for selected Part B drugs.

Prevent Blindness is actively tracking developments on implementation of the IRA, and we will engage with CMS on behalf of patients who rely on treatments and therapies to manage their eye conditions and diseases.