Rx Bills Could Soon be Lower for Seniors

The Build Back Better Act continues to be a work in progress, but a recent version passed by the House of Representatives gives seniors a reason to cheer. The bill now contains provisions that could help seniors who rely on the Medicare Part D pharmacy benefit cut their out-of-pocket costs for prescription drugs.

The reform would ease many seniors’ concerns. Of all potential health care costs, the amount of money they spend on prescription drugs is the one that worries Medicare beneficiaries the most, according to a recent poll.

A few notable reforms that have been added to the bill include:

  • Capping out-of-pocket costs at $2,000 per year.
  • Establishing a “smoothing” approach that would spread patients’ deductible drug costs out over 12 months, instead of forcing them to make a large up-front payment at the beginning of the year, as present rules require.
  • Eliminating the infamous “doughnut hole” that leaves Medicare patients responsible for the entire cost of their prescriptions between the initial and end phases of their coverage.

Prescription adherence is key to managing many chronic conditions, which makes affording their medications a necessity for seniors’ wellbeing. In fact, an increase of just $10.40 per prescription leads to a 23% drop in total drug consumption and a 33% increase in mortality, according to the National Board of Economic Research.

Ensuring seniors can afford their medication so they don’t have to ratio or skip doses would yield savings elsewhere in the health care system. Healthier seniors will have fewer doctor’s visits and medical tests, for example. And they are less likely to incur expensive medical bills from emergency room visits or hospitalizations.

The legislation will be considered by the Senate next. And even though it isn’t a done deal, Congress deserves credit for diligently working to lower seniors’ out-of-pocket drug costs. Patients and advocates alike are hoping Congress will finalize the bill soon.


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