Older North Dakotans and a key advocacy group are hopeful that seniors will see relief from the heavy burden of prescription drug costs - and they're hailing a big step announced this week.

The Biden administration unveiled the first 10 medications that will be subject to price negotiations under the Medicare program. The action is part of the Inflation Reduction Act approved by Congress.

Bismarck resident Bob Entringer has used one of the medications on the list since 2017. When he retired and switched to Medicare, he found out the blood thinner would be almost $500 for a 90-day prescription.

"I didn't envision the cost, actually," he said. "When I went on Medicare, it was literally sticker shock."

Entringer has found ways to work around it, but said it can be complicated. The negotiated prices won't take effect until 2026, and other drugs will be eventually added. Policy experts note that other IRA provisions are already helping beneficiaries.

The pharmaceutical industry is fighting these moves, saying they'll result in a range of ripple effects.

A key industry group has said a number of these drugs already have rebates and discounts. But Josh Askvig,
AARP North Dakota state director, countered that for too long, drug makers have prioritized profits over the people who desperately need some of these medications.

"We know the number one reason seniors skip or ration their prescriptions is because they can't afford them," he said, "and this must stop, and this is an important step in that direction."

The IRA has already capped insulin prices for Medicare recipients and Askvig said they're monitoring a similar pilot program approved by the North Dakota Legislature. Limited in scope, he said he hopes it will eventually be expanded to more populations.

According to AARP, Medicare Part D spent $50 billion on the first 10 drugs selected for negotiation between June 2022 and May of this year. For Entringer, those figures are alarming as he prepares for other medication expenses when his wife transitions to the program in a few years.

"She's on 11 prescription medications - she's got an auto-immune disease," he said, "so it could get very costly for us."

A recent study from Florida Atlantic University highlights a concerning rise in alcohol-related deaths across the United States, with mortality rates nearly doubling between 1999 and 2020.

The findings point to significant public health challenges, particularly among younger age groups and in the South.

Dr. Charles H. Hennekens, professor of medicine and preventive medicine at Florida Atlantic University and the study's co-author, analyzed data from the U.S. Centers for Disease Control and Prevention's "WONDER" database.

"There was a doubling of the mortality from alcohol-related deaths that we saw at all ages," Hennekens reported. "The most alarming spike, nearly fourfold, was in those 25 to 34 years of age."

The number of alcohol-related deaths skyrocketed from just over 19,000 to nearly 49,000. Experts said the findings should be a wake-up call for Florida, where nightlife and tourism are key drivers of the economy. Hennekens urged health care providers to step up screening for alcohol use and educate patients about the dangers.

Hennekens stresses rising rates of obesity and diabetes exacerbate the problem, highlighting one immediate effect of excessive alcohol consumption is liver damage, which can lead to cirrhosis and liver cancer.

"This also contributes to early liver damage," Hennekens pointed out. "These two deleterious effects may be additive or perhaps even synergistic and may contribute to greater and earlier onset of alcohol-related mortality."

While moderate alcohol consumption, defined as up to one drink per day for women and two for men, may have some benefits, Hennekens cautioned against misconceptions. He explained it doesn't matter whether it is a glass of wine, a shot of liquor or one bee, it is about the quantity, not the type. People who drink moderate to large amounts have the highest risk of premature mortality and morbidity.


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The number of Medicare enrollees is projected to rise over the next few years as the baby boomer population ages. More than 2 million Illinoisans are currently enrolled in the federal health care program, according to Healthinsurance.org,

The Office-Based Facility Association, a coalition of practitioners, is calling for a change in what they view as an ineffective and unfair pricing structure of the Medicare Physician Fee schedule.

Jason McKitrick, executive director of the association, said other payers linking themselves to Medicare is one of the issues.

"When you've got ongoing cuts to Medicare, that means you've likely got ancillary cuts going on with the private side, with the Medicaid side, etc.," McKitrick explained. "It's the Centers for Medicare and Medicaid Services, CMS, ultimately, that's the agency and the federal government that sets the rates for the Medicare Physician Fee Schedule."

The association pointed out the current fee schedule addresses doctor's fees only, not the costly and necessary supplies and equipment needed for their practices. According to the Centers for Medicare and Medicaid Services data, there are 300 office-based services under the fee schedule for which Medicare reimbursement is less than the direct costs, before even considering other costs like overhead and physician work.

Dr. Sreenivas Reddy, a vascular interventional radiologist in Hinsdale, said in addition to seeing patients, he has to monitor overhead expenses such as office space and employee salaries, both affected by inflation. Not having the proper medical equipment and supplies, he added, limits his ability to perform specialized procedures and forces patients to seek care elsewhere.

"That makes these patients go to the hospital-based facilities," Reddy noted. "We have to close our offices and try to join these hospital-based models. They would love to come to the office, get the procedure done in one or two hours, versus it takes like a whole day in the hospital setting."

Reddy emphasized physicians' reimbursement, based on the current physician pay schedule, has been on the downtrend for the last five years. The group has further concerns about a decrease in the number of private practices causing more medical deserts for interventional radiology, cardiology, vascular surgery, radiation and oncology care.

Farm advocates say price gouging on meat and poultry are taking a toll on Montanans.

A farm group cites U.S. Department of Agriculture data as proof of corporate greed, and says companies are still using supply-chain issues as an excuse for inflated prices.

Companies faced massive supply-chain disruptions during the pandemic. But Ag Department data show most of those problems are gone - and food prices in Montana haven't dropped.

Groceries here are 5% higher than the national average and egg prices are up 50% since last year, according to the Consumer Price Index.

Joe Maxwell, chief strategy officer with Farm Action, said food producers are looking for ways to keep prices artificially inflated.

"And it's just a part of their doing business now," said Maxwell. "They find excuses in the markets to gouge that consumer. And one thing we want to be very clear on is that the consumer knows it's not the farmer. The farmer's getting squeezed just as much as is the consumer."

Food producers have blamed the supply chain, but also plant closures and a strain of avian flu for supply and demand issues - driving up production costs.

Farm Action is the same group which, not long after the official end of the pandemic, asked the Federal Trade Commission to investigate egg prices - which had tripled in some cases.

Maxwell said Ag Department data show the numbers did not justify the price hike, and adds corporate food producers have positioned themselves to have outsize control over the market.

"They've got that control over the farmer, not unlike oil companies have over oil fields," said Maxwell. "They now have that control because there are very few buyers of farmers' commodities, so they have that control over the farmer, the producer."

Farm Action has also been critical of large, corporate operations that raise thousands of animals in confined spaces, which have been known to pollute air and groundwater.





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