Defending Carolyn – and 37 Million Other Americans Like Her

Carolyn Hill suffers from high cholesterol, high blood pressure and low calcium. But “I don’t let it stop me,” she told one of my colleagues. “I just take my medicine and keep going.”

Carolyn has access to these prescriptions thanks to biopharmaceutical innovation and Medicare Part D, the government program providing affordable access to prescription drug coverage for seniors and people living with disabilities. But it does more: Part D helps ensure seniors like Carolyn retain their freedom and the quality of life they deserve. “Right now, I’m almost 76, she says, “and I can outrun my grandchildren.”

Unfortunately for Carolyn and her 37 million fellow Part D beneficiaries, some are calling to fundamentally change the successful program, even while Part D costs $349 billion less than initial 10-year budget projections and has a 90 percent satisfaction rating from beneficiaries like her.

With Medicare Open Enrollment starting today, October 15, and running until December 7, here are just a couple reasons why we need to fight back against these attacks on America’s seniors and our neighbors living with disabilities and not mess with a good thing.

First, it is wrong to claim there would be any benefit in the government interfering in Medicare Part D price negotiations when Medicare plans already command steep rebates and discounts for seniors. In fact, the non-partisan Congressional Budget Office states that government interference “would have little, if any, effect on prices…because private drug plans are already negotiating drug prices” in the Medicare Part D program. The competitive structure of Medicare Part D gives private plans massive leverage to negotiate discounts. These negotiating plans represent as many as 125 million covered lives – far more than the 37 million Part D beneficiaries – and they compete intensely in hopes of adding more enrollees.

This kind of competition ensures seniors and people living with disabilities have access to a wide choice of plans to meet their individual needs while keeping premiums low. In fact, 2016 average premiums are projected to remain stable and will be about half of original projections. Competition gives beneficiaries like Carolyn a choice of plans to find the one that works best for her.

Further, if the government ignores CBO’s and others’ guidance and interferes with Medicare Part D, it would need to limit access or implement coverage restrictions on medicines to realize any savings, hurting beneficiaries in the process. In fact, the Department of Veterans Affairs already uses government price controls and restrictive formularies that limit access to medicines in order to achieve savings, leaving many veterans to supplement VA coverage with Part D or private insurance to get the medicines they need.

As for Carolyn, she plans to keep her quality of life, taking her medication “so I can keep living to be 100 years old,” she says.

We need to support policies that help – not hinder – people like Carolyn’s access to the medicines they need to help them live longer, healthier lives.


John Castellani is president and CEO of PhRMA.

Morning Consult