America's Benefit Specialist July 2023

Expect More FROM YOUR GENERAL AGENCY M FROMYO

Even if Medicare were to cover Leqembi, patients administered the drug would be responsible for 20% of the cost, or more than $5,000 out of pocket in cost sharing each year, unless they have coverage that covers a portion of these costs. With high er rates of dementia and lower incomes among older Hispanic and black adults than among older white adults in the U.S., black and Hispanic beneficiaries may be less likely to get this treatment if they can’t afford it. If covered by Medicare, these drugs could be among the limited number of drugs that would be subject to Medicare’s new drug price negotiation authority under the Inflation Reduction Act—but not for several years. For example, man ufacturers of biologic drug products like Leqembi would be exempt from having Medicare-negotiated prices take effect for 13 years from the drug’s licensure date, which for Leqembi itself would be no sooner than 2036. For one of the small-molecule drugs being used for weight loss, negotiated prices could po tentially take effect in 2027. Another provision of the law will cap out-of-pocket Part D spending at $2,000 in 2025. The cap would make weight loss drugs more affordable if they are covered under Part D, but the law’s new cap does not limit out-of-pocket spending for drugs that are covered under Medicare Part B, as would be the case with Leqembi. For the full analyses, as well as more data and analyses about Medicare and prescription drugs, visit www.kff.org.

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TWENTY-TWO PERCENT OF PEOPLE HAVE A DIAGNOSED BEHAVIORAL CONDITION; THEY ACCOUNT FOR 41% OF HEALTHCARE SPEND

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Behavioral health encompasses individual and family well-being, as well as a wide range of conditions that differ in degree of intensity and impact. As with physical health, behavioral health affects patients in highly personal and unique ways. And

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