Q&A: How The 2024 Election Looms Large Over Pharmacy

Lindsay Bealor Greenleaf, Vice President and Solution Leader, Federal and State Policy at ADVI Health, sat down with Drug Topics at AXS24, the Asembia Specialty Pharmacy Summit, to discuss the pressing issues that are pharmacists are facing ahead of the 2024 presidential election.

Drug Topics:What are some of the most pressing 2024 election issues that may potentially impact pharmacy practice?

Pharmacists are closely watching the outcome of the 2024 presidental election. | image credit: vchalup - stock.adobe.com

Lindsay Greenleaf: I think one big issue that pharmacies are looking at is what's going on with Part D redesign, and what is their role going to be with the copay smoothing policy [in] the Medicare payment program. We've had guidance come out from [the Centers for Medicare & Medicaid Services] on how this should look, but I think there's still a lot of unanswered questions. The fact that patients are not automatically enrolled is going to cause a lot of confusion. I think pharmacists are going to be the first ones to be fielding these questions from patients. I think that's something [to keep] top of mind that pharmacists are going to have to be ready for in 2025.

From an election standpoint, the fate of the Inflation Reduction Act is something that will have big implications depending on who wins this election. The law is obviously going to still be in place—unless it's repealed, which is very unlikely—but it would certainly be implemented in a different way if it was under President Trump or President Biden.

Drug Topics: How might the election impact the Inflation Reduction Act, and the provisions within it around drug pricing?

Greenleaf: The Inflation Reduction Act is very likely to be implemented next year, regardless of who is in the White House. Getting rid of it would either require Republicans taking full control of Congress and them having the political will and desire to fully repeal it because it will cost a lot of money. You have to find pay floors, and it's always really challenging to do. There's also potential for it to be struck down in the courts—we just had a court decision yesterday—[but] that has not been going in the manufacturers’ favor so far. So, it looks like the Inflation Reduction Act is here to stay, at least in the in the near term.

The key will be, though, how a future President Trump might implement it versus President Biden. We would think that if President Trump were to come back to office, he would maybe try to implement it in a less punitive way, if possible, especially when thinking about government negotiation of drug prices. The agency has a lot of authority with where they're going to set those prices and you would think, under a Trump administration, government prices might come in close to the ceiling price. And another piece—we would think and hope [that we’d] get a lot more transparency of how the law [will be] rolled out under a Trump administration as compared to what we're getting now [under the] Biden administration. If we have another Biden administration, [we] would expect for the law to continue implementation as it's going. We know that President Biden would love to expand on the law even though it's just ramping up right now. We don't have any of these government-negotiated prices applying, yet we know he'd like to expand it to 50 drugs targeted for a year. That would require legislative change, but that is something that we're going to be watching closely to see what the power of Congress looks like and [whether] that's something that Congress might take on next year.

And then from there, just continuing to watch the rollout of Part D benefit redesigned. Those will be the big things we are watching this [upcoming] year.

Drug Topics: What are the top actions that pharmacists can take to address issues around medication affordability?

Greenleaf: I think the best way that pharmacists can help with affordability is to help patients with this copay smoothing policy that's going to be coming into play in 2025. There's still just a lot that we don't know yet. This guidance is still rolling out. This is going to be a really big undertaking in terms of how we're going to spread out these out-of-pocket costs throughout the year. I think [that] paying close attention to the guidance [and] understanding what exactly is expected of them—I think that's really the best that a pharmacist can do for next year.

AXS24, the Asembia Specialty Pharmacy Summit, was held April 28 to May 2 in Las Vegas, Nevada. Click here for more of our coverage from AXS24.