By Janelle Fisher
City Pages Editor
GREEN BAY – Sen. Tammy Baldwin stopped by the Aging and Disability Resource Center of Brown County to speak on the healthcare provisions in the recently enacted Inflation Reduction Act at an event hosted by Protect Our Care Wisconsin.
Effective Jan. 1, seniors covered by Medicare will see copays for insulin capped at $35 per month, and those on Medicare Part D will be able to access vaccines, such as those for shingles and TDaP, at no cost.
Two local seniors, Martha Rendon of Green Bay and David Hovde of Appleton, also attended the event to share how the new provisions will impact them.
“My husband and I had our shingles vaccines about three years ago now,” Rendon said. “It was $200 per shot, and that was the copay. If we hadn’t had any insurance, it would have been about $450 per shot. To me, it was a small price to pay but it’s still a big chunk of money because it’s a two-shot deal and so for our four injections, it was $800. That’s a lot of money to come out of your budget. I can afford it if I have to pay it, but I just think, what about other people?”
Some insurance providers are reluctant to cover the vaccine because it’s not considered life-saving, but Rendon said that there are other factors that make vaccines worthwhile and should be considered.
“Their rationale, when I talked to somebody about it, was that it’s not necessarily a life-saving vaccine,” she said. “And it isn’t, but it’s a quality-of-life vaccine. My husband had shingles when he was 36 or 37 years old… It was excruciating… For many years I could see the scars.”
Rendon said the peace of mind she got from the vaccine made it more than worthwhile for her — even with the high copay.
“With the shingles vaccine, after the first [injection] I had a sore arm. The second one… I just felt like I had the flu for two days,” she said. “But I’ve pretty much guaranteed that I’m not going to get shingles again or ever, and for that I am so appreciative.”
It’s not just the shingles vaccine that are now accessible for no cost, though. The TDaP vaccine, which prevents illnesses including
“I needed the TDaP vaccine last year,” Rendon said. “I think I paid $40 for it, which again I can afford, but it cost me. As a senior citizen, if I were to get it myself, I have asthma and I could very possibly get very sick with pertussis. And if I exposed little kids to it, or an infant to it, they could die. I could die.”
With the cost barrier now removed, Rendon said she hopes more people are able to get the vaccines they need to protect themselves and those around them.
“Hopefully now that TDaP is completely covered, people won’t let that vaccine slide,” she said.
Hovde, who is a recently-retired diabetic, spoke to the impact of the insulin copay cap.
“I’ve taken insulin now for about 15 years,” he said. “Insulin is really expensive. When I first started taking it, when my insurance was not so good, it still covered part of it. It was $2,000 every 90 days [out of pocket]. More recently, I had good insurance when I was still working. Nonetheless, my out-of-pocket cost was nearly $700. That’s a lot of money. It felt a little bit different paying that when I was working than it does after I retired.”
Hovde said the copay cap of $35 is important to ensure people get the drug they need to stay alive, but also to keep up their quality of life.
“There are plenty of people who would find it a huge struggle, if not impossible, to pay what they might be required to pay if they don’t have insurance or if their insurance isn’t good,” he said. “They’re paying a premium for that and it is a lifesaving drug. For people who take it, it is also a quality-of-life drug. [Insulin] affects how a diabetic feels. It can reduce the impact of a host of really awful risks diabetics face — neuropathy, cardiac issues, vision. It is a quality of life issue and it is a preventative measure.”
Some diabetics ration their insulin due to the cost, Hovde said. The new copay cap, he said, will hopefully give them the ability to use what they need without worrying about being able to afford it.
“We’ve heard the horror stories about diabetics who maybe don’t take the shots every time they need them, because they know that they’re not going to end up in the hospital, just to try and stretch their supply so a three-month supply lasts for four months and they just don’t feel quite right at any point of that,” he said. “Now, with this cap at $35 a month, folks who need insulin can take the shots they need as they need them and make sure they’re feeling healthy.”
Baldwin said these healthcare provisions and the Inflation Reduction Act as a whole are a huge step forward.
“We hear of far too many people who were forgoing the care that they need or prevention services that they need to stay well and healthy,” she said. “The Inflation Reduction Act and these things that have now kicked into effect at the beginning of 2023 are just really exciting because they are solutions for challenges that we face.”