Smoothing Medicare Beneficiaries’ Out-of-Pocket Drug Costs

Friday, November 15, 2019

Below is an exerpt from an op-ed published today by Morning Consult. In it, Marc Boutin, JD, National Health Council Chief Executive Officer, and Sue Peschin, MHS, President & Chief Executive Officer of the Alliance for Aging Research, write, "We applaud those in Congress who are working tirelessly to reach bipartisan agreement for important changes, most notably adding a cap on out-of-pocket expenses." Read the full op-ed.

In 2003, the Medicare Modernization Act was signed into law to add the Part D prescription drug benefit to Medicare for our nation’s older adults and people with disabilities. While the program has been a huge success in its 15-year existence, much has changed over that time.

New types of therapies have come to market and the time is right for Congress to update Medicare Part D. We applaud those in Congress who are working tirelessly to reach bipartisan agreement for important changes, most notably adding a cap on out-of-pocket expenses.

While the current Medicare Part D benefit is wildly popular and works well for most people, it is the only type of health insurance in America that does not have a limit on out-of-pocket expenses such as deductibles and copays, keeping access out of reach for many of those most in need of treatment. Leaders in both chambers of Congress have proposed changing this by redesigning the benefit to include a cap. The Senate has proposed an annual cap of $3,100, while the proposal in the House of Representatives includes a cap of $2,000.

While these proposals will help many Medicare beneficiaries, we are concerned that some patients with complex, chronic conditions living on fixed incomes will have drug costs that will cause them to hit the cap very early in the plan year, for some in their first or second visit to the pharmacy counter. Not only does this put financial strain on patients and their families, but far too often, patients with these high upfront costs choose to skip their prescribed medication entirely because they are unable to shell out thousands of dollars at one time.

Read the full op-ed.