Growing out-of-pocket costs in Medicare Part D are a heavy burden for many older Americans. There is no limit to what patients must pay in the program and some patients receive bills for a single prescription drug fill in the thousands of dollars.
Patient Advocacy Groups Call for Bipartisan Action to Alleviate Older Americans’ Undue Medicare Part D Cost Burden
Published July 20, 2020
WASHINGTON, July 20, 2020 – Before the Coronavirus disease 2019 (COVID-19) pandemic, many older Americans and people with chronic diseases were foregoing their prescribed medications due to high out-of-pocket costs. The ongoing pandemic has only exacerbated prescription drug affordability concerns. This is the impetus behind the Alliance for Aging Research (the “Alliance”), along with 48 partner organizations, in urging Congress to make two key reforms to Medicare Part D in the next COVID-19 financial relief package.
The reforms were detailed in a letter sent today from the Alliance-convened Project LOOP (Lowering Out-of-Pocket Costs) initiative. The letter asks Congressional leaders – Speaker of the House Nancy Pelosi, Minority Leader Kevin McCarthy, Majority Leader Mitch McConnell, and Minority Leader Chuck Schumer – to address out-of-pocket (OOP) costs in Medicare Part D by placing a cap on beneficiaries’ costs and providing the option to smooth costs over the course of a year. While the timing and content of the next relief package are still under consideration, health care affordability should be addressed in addition to priorities like education and jobless benefits.
The COVID-19 pandemic has made already high OOP costs even less affordable, especially for older Americans on fixed incomes and those living with chronic diseases like diabetes, heart disease, and chronic obstructive pulmonary disease. Before the pandemic, 1 in 5 adults age 60 and older reported struggling to afford their prescription drugs, and in many cases abandoned treatment altogether, leading to life-threatening consequences. Not filling, delaying, or curtailing the use of prescription medications can have life-threatening consequences. As a result, excessive OOP costs can lead to patients making difficult choices between financial solvency and their health.
COVID-19 has intensified the burden of out-of-pocket costs for patients, further amplified by the accompanying economic downturn. Though Medicare covers necessary services in case of COVID-19 infection, patients are still responsible for copayments and deductibles.
“The pandemic has disproportionately impacted older Americans and those living with chronic disease, making a bad situation worse for Medicare beneficiaries,” says Susan Peschin, MHS, Alliance president and CEO. “Alleviating patients’ financial strain is not just the right thing to do—it is essential. Congress needs to act now. It simply cannot wait any longer.”
The letter released today implores Congress to create an annual cap on patient costs and a smoothing mechanism in Medicare Part D. Instituting a cap on the total costs that patients are required to pay each year would help beneficiaries afford the medicines they need rather than forcing beneficiaries to abandon treatment due to financial strain.
In addition, a smoothing mechanism would help spread out the cost of prescription drugs over time, like a monthly payment plan. It would ensure patients are not required to pay an entire year’s worth of out-of-pocket costs in January or upon starting a new course of treatment. These proposed policy solutions would provide financial security for the most vulnerable patients and ensure access to needed medicines.
Project LOOP also cautions in the letter that solutions to OOP costs should not be accompanied by proposals such as international reference pricing which relies on methodologies that devalue patients based on their disability, age, or chronic illness and potentially limits access to treatment. Rather, beneficiaries ought to have equitable coverage for medically necessary treatments without regard to personal characteristics or health status.
The following organizations signed the Project LOOP letter:
- Allergy & Asthma Network
- Alliance for Aging Research
- Alliance for Patient Access
- American Association on Health and Disability
- American Society of Hematology
- Amyloidosis Support Groups, Inc.
- Caregiver Action Network
- COPD Foundation
- Cure HHT
- Cutaneous Lymphoma Foundation
- Depression and Bipolar Support Alliance
- FND Hope
- Genetic Alliance
- Global Healthy Living Foundation
- Global Liver Institute
- GO2 Foundation for Lung Cancer
- Haystack Project
- Hermansky-Pudlak Syndrome Network
- HIV + Hepatitis Policy Institute
- International Pemphigus Pemphigoid Foundation
- Kids With Heart National Association for Children’s Heart Disorders, Inc.
- Lakeshore Foundation
- Lupus and Allied Diseases Association, Inc.
- Lupus Foundation of America
- Men’s Health Network
- MLD Foundation
- Movement Disorders Policy Coalition
- National Alliance for Caregiving
- National Alliance on Mental Illness
- National Association of Area Agencies on Aging
- National Kidney Foundation
- National Organization for Tardive Dyskinesia
- National Psoriasis Foundation
- National Urea Cycle Disorders Foundation
- NBIA Disorders Association
- Parkinson & Movement Disorder Alliance
- Partnership to Fight Chronic Disease
- PTEN World
- RASopathies Network
- Respiratory Health Association
- Sophie’s Neighborhood
- The Mended Hearts
- The Michael J. Fox Foundation for Parkinson’s Research
- The Myositis Association
- Tuberous Sclerosis Alliance