Growing out-of-pocket costs in Medicare Part D are a heavy burden for many older Americans.
132 Patient, Disability & Provider Organizations Urge Congress to Enact Meaningful Reforms to Improve Prescription Drug Affordability for Older Adults in Medicare Part D
Published September 9, 2021
WASHINGTON, September 9, 2021 – Today, the Alliance for Aging Research (“Alliance”) and 131 other organizations representing older Americans, patients, family caregivers, people with disabilities, diverse communities, and healthcare providers delivered a letter to key House and Senate committee leaders calling for meaningful reforms to address the heavy burden of out-of-pocket costs for Medicare Part D beneficiaries. The letter urges leaders of the Senate Committee on Finance, House Committee on Energy and Commerce, House Committee on Ways and Means, and House Committee on Education and Labor to deliver concrete reforms to improve affordability for Medicare Part D beneficiaries in the budget reconciliation process.
In the letter, these groups share three specific recommendations to help the most vulnerable Medicare Part D patients better afford their medications:
- Create an Annual Cap on Medicare Part D Prescription Drug Out-of-Pocket (OOP) Costs. Instituting a monthly OOP cap or coalescing around a proposed annual cap of $2,400 or lower would provide meaningful relief for older adults and people with disabilities in Medicare Part D.
- Pair an Annual Out-of-Pocket Cost Cap in Medicare Part D with a Cost “Smoothing” Mechanism for Older Adults. A well-designed “smoothing” mechanism would give beneficiaries the option to evenly spread OOP costs over a plan year, thereby avoiding large lump sum expenses.
- Determine if a Maximum Copay Payment Model Would Benefit Patients Across Conditions. The Part D Senior Savings Model currently allows patients with diabetes enrolled in participating Medicare Part D plans to access insulin for just $35 per monthly prescription.
The letter states, “The current OOP burden faced by beneficiaries impedes patient access to prescribed medications. These costs are especially acute when deductibles and benefits reset at the beginning of each year. A growing body of evidence shows increases in patient OOP costs lead to lower drug adherence, higher mortality, and increased overall healthcare costs.”
Additionally, the groups call on Congress to reject drug proposals that use the Quality Adjusted Life Years (QALY) methodology or similar “average metrics” drug value assessment frameworks that could limit treatment access and discriminate against certain populations, including older Americans and those with a disability. The letter states, “As Medicare is the primary source of health insurance for older adults and people with disabilities, utilizing QALYs or similar metrics in pricing would be particularly harmful to the very groups the program is intended to serve.”
“Patients should never have to choose between their health and paying for other basic costs of living,” said Michael Ward, Vice President of Public Policy of the Alliance. “Upcoming Congressional legislation must improve the lives of as many Medicare beneficiaries as possible to provide a long-term fix for these problems, and Congress must do so without introducing harmful methodologies that would disadvantage older adults and people with disabilities.”
The sign-on letter was delivered to Senate Committee on Finance Chairman Ron Wyden and Ranking Member Mike Crapo, House Committee on Energy and Commerce Chairman Frank Pallone and Ranking Member Cathy McMorris Rodgers, House Committee on Ways and Means Chairman Richard Neal and Ranking Member Kevin Brady, and House Committee on Education and Labor Chairman Bobby Scott and Ranking Member Virginia Foxx.
The Alliance is the convener of Project Lower Out-of-Pocket (Project LOOP), an ad hoc collective of patients and organizations committed to addressing prescription drug affordability challenges in Medicare.
About the Alliance for Aging Research
The Alliance for Aging Research is the leading nonprofit organization dedicated to accelerating the pace of scientific discoveries and their application to vastly improve the universal human experience of aging and health. The Alliance believes advances in research help people live longer, happier, more productive lives and reduce healthcare costs over the long term. For more than 30 years, the Alliance has guided efforts to substantially increase funding and focus for aging at the National Institutes of Health and Food and Drug Administration; built influential coalitions to guide groundbreaking regulatory improvements for age-related diseases; and created award-winning, high-impact educational materials to improve the health and well-being of older adults and their family caregivers. For more information, visit www.agingresearch.org