Opinion

Seniors Struggle With Out-Of-Pocket Drug Costs. A Cap Would Fix This

Recently, the Senate Committee on Finance advanced legislation to lower prescription drug costs and cap out-of-pocket Medicare Part D expenses for seniors. As Congress moves forward with solutions to help ease the burden of health care costs for older adults, they must prioritize efforts that will cut out-of-pocket spending for Medicare beneficiaries at the pharmacy counter.

Out-of-pocket costs for prescription drugs can be so high that many patients forego their prescribed medication. A recent Morning Consult survey commissioned by the Alliance for Aging Research found that 1 in 5 older adults age 60 and older are struggling to pay for prescription drugs. Of those who deal with at least one chronic condition, nearly 1 in 4 (24 percent) report they have stopped taking a prescription medication because of the cost. These findings deserve a strong and united policy response.

Three in 4 older adults support Congress passing legislation that would place a cap or limit on Medicare Part D out-of-pocket costs, and more than half of Medicare beneficiaries (52 percent) are willing to pay a few extra dollars a month in Medicare premiums to help make it happen. When asked to choose between a monthly and an annual cap, 46 percent support a monthly cap versus 24 percent who support an annual cap. Surprisingly, the Congressional Budget Office released an analysis of the legislation and determined premiums would decrease.

There is a known reason for the monthly cap preference. As it currently stands, beneficiaries taking high-cost medications bear a significant financial cost at the beginning of their plan year. This is because specialty medications can “burn through” the enrollee’s deductible, as well as the initial coverage phase very quickly.

According to the Medicare Payment Advisory Commission, high-cost enrollees will spend an average of $2,140 on Part D drugs per month. For many older adults, this means they must pay a significant portion of their fixed incomes over a short duration of time. Congress must consider policy solutions to smooth these expenses over the course of a benefit year to assist those dealing with these concentrated medication costs in the earliest months.

Medicare Part D is supposed to ensure that prescription drugs are affordable for seniors, and it should be acknowledged that Part D is working well for the majority of the 47 million Medicare beneficiaries enrolled in the program in 2019. Yet, 1 million Medicare Part D beneficiaries spent on average more than $3,200 each in 2017 for out-of-pocket costs.

For the 25 million adults age 60 and older living under the federal poverty level of $29,425 per year per person, $3,200 is no small sum. And this is solely for out-of-pocket prescription costs, not including any other health expenses.

Even adults ages 60 to 64 not yet on Medicare are just as likely as Medicare beneficiaries surveyed to support legislation to place a cap on out-of-pocket Medicare Part D spending. They recognize a time may come when they might also struggle.

Ultimately, the total costs of care for older patients need to be addressed in addition to their Part D costs. Too many beneficiaries are having difficulty affording their physician and clinic visits, hospital stays and other health care procedures and services.

Access to care is impacted by the totality of premiums, copayments, coinsurance and deductibles — across the care continuum. Addressing access to prescription therapies is an ambitious first step to fixing the many problems in the “access to care” issue.

Older adults clearly support Congress passing legislation that would place a cap or limit on Medicare Part D out-of-pocket costs, and more than half of Medicare beneficiaries are willing to pay a few extra dollars a month in Medicare premiums to help make it happen. If Congress and the administration are serious about addressing Part D out-of-pocket drug costs, the ball is in their court.

 

Sue Peschin, MHS, serves as president and CEO of the Alliance for Aging Research in Washington, D.C.

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