Project LOOP (Lowering Out-of-Pocket) Costs

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. Too often the sickest and most vulnerable patients pay the highest amount for their medicines. The current pandemic only exacerbates the problem. During these stressful times beneficiaries should not have to worry about how they are going to pay for their medication. It’s time for Congress to act!

GET IN THE LOOP: Share your story of high out-of-pocket costs in Part D by emailing [email protected].

A Call for Action

Simple bipartisan solutions exist to curb patients’ health care expenses: we urge Congress to act now to address this problem by smoothing and capping out-of-pocket costs in Medicare Part D. This is a growing problem that is heightened by the coronavirus pandemic.

A cap on the total amount patients are required to pay would help beneficiaries get the medicines they need rather than skipping doses, ending treatment or getting turned away at the pharmacy counter. But even with a cap, patients may be required to pay a large amount all at once; a smoothing provision would spread out the costs overtime to ensure Medicare beneficiaries are not overwhelmed with large out-of-pocket spending all at once. As we work to protect older Americans from COVID-19, this is the time to relieve beneficiaries of undue financial burden – now and going forward.

Patient Advocacy Groups Call for Bipartisan Action to Alleviate Older Americans’ Undue Medicare Part D Cost Burden

On July 20, 2020, the Alliance for Aging Research and 48 other patient advocacy organizations sent a letter to 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. The groups also caution 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. Click here to read the letter and here to read the official press release.

Individuals can contact their Congressional Representative and Senators to ask them to address Medicare prescription drug out-of-pocket costs through an annual cap and smoothing mechanism.

Advocacy Groups Send Letter to CMMI on Part D Demonstration

On May 22, 2020, the Alliance for Aging Research and 26 other patient advocacy organizations wrote to the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) to show support for a “smoothing demonstration” included in the Innovation Center’s Part D Modernization Request for Applications (RFA). Click here to read the letter.

  • On July 16, 2020, CMMI responded to the letter. In the response, CMMI outlined:

    • CMMI will announce the Part D sponsors participating in the Part D Modernization model in fall 2020;
    • CMMI will continue its efforts to support participation in the CY22 Part D Modernization model, mainly through educating Part D sponsors with webinars and discussions;
    • CMMI offered the opportunity to connect with the cosigners of the letter and other stakeholders as they plan for CY22;
    • CMMI encouraged the cosigners of the letter to look at the Part D Senior Savings model.

Interested in lending your voice in support of lowering out-of-pocket costs for Medicare beneficiaries? Join Project LOOP by emailing [email protected].