By Dan Klein
February 2, 2021 at 5:00 am ET
As President Joe Biden and Vice President Kamala Harris set the course for their administration amid a global health emergency, we hope they will support meaningful legislation to improve health care affordability and access for the millions covered by Medicare and commercial insurance. After reviewing Biden’s health care plan, we have identified a few key strategies that would augment his plan and provide much needed help to these patients.
There were more than 46 million adults enrolled in the Medicare Part D prescription drug program last year. The median annual income of Medicare beneficiaries — a group composed of adults over 65 and younger adults with disabilities — is $26,000. And yet, they remain the only group of insured people in the United States not protected by a cap on annual out-of-pocket prescription costs.
Without a cap, millions of adults face high out-of-pocket costs that they simply can’t afford. This is especially true for patients who require medications to treat serious illnesses, like cancer. Just one prescription can cost as much as $16,000 out of pocket each year, according to a recent Kaiser Family Foundation analysis. That means patients who need life-saving drugs might have to spend more than half of their annual incomes on a single medication, in addition to the many other costs associated with their treatment.
The Biden-Harris administration and 117th Congress should immediately enact a cap on annual out-of-pocket spending and spread the remaining out-of-pocket prescription costs more evenly throughout the year.
Currently, beneficiaries of Medicare Part D prescription drug plans face high out-of-pocket costs early in the year before they’ve reached their deductible limit, forcing many with a fixed income to decide whether to allocate their budget toward medications or groceries. Smoothing these costs would offer relief from looming financial burdens each January when healthcare plan deductibles reset. A cap would offer relief for the rest of the year, especially for people who face ongoing treatment for expensive conditions like Parkinson’s disease or multiple sclerosis.
The new administration has plans to increase the value of tax credits to extend coverage to more Americans, recognizing that many don’t qualify for help, yet still struggle with healthcare costs. In that same spirit of increasing health care access and affordability, the Biden-Harris administration should also prioritize expanding the eligibility requirements for the Medicare Part D Low-Income Subsidy program, a federal financial aid program that can lower what an individual pays out of pocket for medications.
Because the current eligibility criteria for the LIS program requires patients to have an extremely low income, millions of Medicare beneficiaries who are economically insecure but slightly above the limit are unable to afford their prescriptions and don’t qualify for additional aid.
Finally, we were pleased to see Biden’s plan note that “even for people with health insurance, our healthcare system is too expensive and too hard to navigate.” It’s true. And it’s one of the reasons the Biden-Harris administration should prohibit copay accumulators and similar programs that hurt individuals with life-threatening, chronic and rare diseases. Many patients have come to rely on pharmaceutical company copayment cards, or coupons, to afford their treatments. The problem is that commercial insurance copay accumulator policies do not usually count card and coupon use toward patients’ deductibles, resulting in a much larger overall out-of-pocket financial burden.
In my capacity as CEO of one of the nation’s largest charitable organizations helping the underinsured, I have seen far too many examples of patients living with serious illnesses and serious worries about how they will be able to afford the price of their critical prescription medications. In their first 100 days, we hope that President Biden, Vice President Harris and the 117th Congress will take steps to change that.
Biden makes it clear: “Every American has a right to the peace of mind that comes with knowing they have access to affordable, quality health care.” We agree and welcome legislation to make that statement a reality.
Dan Klein has served as the president and CEO of the PAN Foundation since 2014; he previously served as senior vice president for the Cystic Fibrosis Services specialty pharmacy at the Cystic Fibrosis Foundation.
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