As Congress considers proposals to bring down drug costs for seniors, one plan they must consider is capping the out-of-pocket costs for Medicare Part D beneficiaries.
This is an issue important to members of the Ohio State Grange, many of whom are seniors who depend on Medicare benefits. Our membership is closely watching drug pricing reform proposals before Congress right now. While we applaud efforts to lower drug costs, we want to be sure any changes to Medicare will help patients directly.
One proposal before federal lawmakers recognizes the harsh reality that many beneficiaries have experienced when using their Part D plan. Part D drug coverage does not cap out-of-pocket patient costs. Private health plans and plans in the Affordable Care Act (ACA) do cap patients’ shared costs on medication. The lack of any limits on what Part D beneficiaries must pay for co-pays or co-insurance can cost some beneficiaries thousands of dollars annually.
For beneficiaries who experienced out-of-pocket cost controls when they used private insurance, the ‘sky is the limit’ approach for Part D is a tough pill to swallow.
The timing to implement out-of-pocket caps in in the Part D program is now. By the end of 2020, the patient’s share of Medicare Part D prescription drug costs will increase. This is happening because of changes in federal law, including an upcoming expiration of a provision in the ACA. These changes mean Part D beneficiaries will pay an additional $1,250 annually for prescription medications before hitting the threshold for catastrophic coverage.
For seniors living on a fixed income, the added costs could take an additional $100 from their monthly budget. For many seniors, this will force spending decisions that could negatively impact overall quality of life. Taking medicine should not compromise seniors’ ability to have enough food, pay for utilities and housing, and have other necessities.
Unchecked out-of-pocket costs are especially problematic for patients with serious, chronic illnesses, who may need specialty drugs to maintain their health. Chronic conditions such as arthritis, cancer, multiple sclerosis and other diseases that call for costly specialty drugs, could result in out-of-pocket costs anywhere from $2,600 to $16,500 annually.
Medication adherence is a concern for physicians, nurses, pharmacists and other medical providers. For seniors, taking their medicine in the right dose at the right time is in the best interests of their health and decreases emergency room use, hospitalizations and unnecessary visits to the doctor. Higher out-of-pocket costs can lead seniors to cut back on dosage, or skip taking their medicine altogether.
We encourage our Ohio members of Congress to support the out-of-pocket cap proposal for Medicare Part D. Ohio is home to more than 2 million Medicare beneficiaries who depend on the program for reliable, affordable medical care. Medication is a critical part of seniors’ ability to maintain health. Any changes to Medicare should ensure affordability for the patient, at the pharmacy counter, and preserve access to medications for our seniors.