The PAN Foundation today announced its 2021 healthcare policy priorities for the incoming Biden-Harris administration and 117th Congress. These recommendations will help ensure that healthcare is more accessible and affordable for Medicare beneficiaries and commercially insured patients living with life-threatening and serious illnesses.
It’s well documented that seriously ill Medicare beneficiaries often face high-out-of-pocket costs. These patients are less likely to fill their prescriptions, stay on medically prescribed treatments, and ultimately face greater struggles maintaining their health. The current structure of Medicare Part D prescription drug plans also front loads out-of-pocket medication costs early in the benefit year. For patients with high cost-sharing and a fixed income, this can put critical medications out of reach. While the Medicare Part D Low-Income Subsidy (LIS) program is a huge help to those who qualify, its limitations exclude millions of Medicare beneficiaries who are economically insecure and unable to afford medications.
For economically vulnerable patients with commercial insurance, pharmaceutical company co-payment cards have become essential in recent years as high-deductible health plans continue to rise. However, commercial insurance co-pay accumulator policies often prevent patients from counting manufacturer co-pay card and coupon use toward their deductibles, resulting in a much larger overall out-of-pocket financial burden for patients.
Therefore, the PAN Foundation urges the Biden-Harris administration and Congress to:
- Place a monthly or annual cap on out-of-pocket costs for prescription medications for Medicare Part D beneficiaries.
- Spread out-of-pocket costs for prescription medications more evenly throughout the Medicare Part D benefit year.
- Modernize the Medicare Part D Low-Income Subsidy (LIS) program to increase enrollment and provide continuity for individuals from one year to the next.
- Prohibit co-pay accumulators or similar programs that lead to greater out-of-pocket costs for commercially insured individuals.
“The average Medicare beneficiary has an annual income of $26,000. They are also the only insured population without a cap on their out-of-pocket costs,” said PAN President and CEO Dan Klein. “These policy changes could make prescription medications more affordable to more than 60 million people in America who rely on Medicare and millions more who are commercially insured. We urge the Biden-Harris administration and Congress to take swift action to improve the affordability and accessibility of healthcare.”
Learn more about our healthcare policy recommendations
To read PAN’s complete list of 2021 policy positions, visit panfoundation.com/positions. To join PAN in advocating for these lower out-of-pocket costs, visit our advocacy action center. In just a few clicks, you can send an email to your elected representatives asking them to make healthcare more affordable and accessible.
About the PAN Foundation
The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic, and rare diseases with the out-of-pocket costs for their prescribed medications.
Since 2004, we have provided nearly 1 million underinsured patients with $4 billion in financial assistance. Partnering with generous donors, healthcare providers and pharmacies, we provide the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Learn more at panfoundation.org.
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