Has Medicare Part D Reform Finally Arrived?

September 30, 2021

For as long as the Medicare Part D prescription drug plan has existed, beneficiaries have struggled with out-of-pocket costs. Now, movement on Capitol Hill suggests this may finally be the year for reform.  

A solution could stem from the current reconciliation process – where Congress is considering budget changes and enhancements to health care programs. If not, four other “Part D” bills are in play, any one of which could reduce the cost burden to improve treatment access for patients.

Calls for Reform 

Reform efforts focus on two key changes: 

  1. A cap on out-of-pocket spending. 

    More than 75% of Americans support an out-of-pocket cap on prescription drug spending in Medicare Part D, according to a Kaiser Family Foundation poll. In fact, such a cap would bring Medicare policy in line with most commercial plans, ensuring fairness for seniors.  

    All of the bills being considered this year feature some form of a cap on out-of-pocket costs. It has become the resounding call to action, garnering broad support from across the aisle as well as from advocacy organizations like Project LOOP, the Medicare Access for Patients Rx Coalition and the Alliance for Patient Access. 

  2. “Smoothing” of out-of-pocket costs. 

    Another crucial improvement on the table is finding a way to “smooth” patients’ out-of-pocket prescription costs evenly over a plan year. This type of measure would create consistency for patients facing a large, upfront payment for their medications at the start of a year. 

The Harm of High Cost Sharing 

Reining in high out-of-pocket costs is key to improving health outcomes for Medicare beneficiaries. 

“An out-of-pocket cost growth of just $10.40 per prescription leads to a 23 percent drop in total drug consumption,” according to a letter authored by advocacy group Project LOOP.  

Patients who struggle to afford their medications may delay starting treatment, skip doses or stop taking medications altogether. As a result, patients are susceptible to worse health outcomes and higher mortality, not to mention the stress and possibility of financial ruin. 

Excessive out-of-pocket costs also drive-up overall health care system spending and are the cause of preventable emergency care.  

Regardless of which legislative approach wins the day, the momentum behind Part D reform is stronger than ever. Seniors can’t – and shouldn’t have to – wait any longer. 

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