The following was written and approved by the undersigned, 22 leading, national patient advocacy organizations.
America’s older adults have endured more than a decade of rising out-of-pocket prescription medication costs with no relief.
After years of starts and stops on Capitol Hill, Congress now has an opportunity to pass urgent reforms that will expand medication, vaccine, and healthcare access for 49 million people insured by Medicare Part D as part of the proposed reconciliation package.
Working at organizations that collectively represent millions of people on Medicare, we hear stories daily of older adults who go into credit card debt, ration pills, or choose between paying their monthly utilities and groceries—all in the name of paying for their prescribed medications.
The proposed plan includes four changes that will directly improve access to medications and preventive vaccines for older adults and people with disabilities on Medicare.
Here is what passing these protections would mean to real people:
Mary, who is 84 and lives with multiple chronic conditions, will no longer have to empty her already dwindling retirement savings to afford the $10,000 annually for her medications, thanks to a provision that caps her medication spending at $2,000 per year.
Not only will Mary be protected by a limit on what she spends on prescription medications, but she can also plan for the expense by choosing to spread what she pays throughout the year, commonly known as smoothing. She will no longer face a tremendous financial burden at the beginning of each year when deductibles reset—a time of crisis for many older adults who suddenly owe jaw-dropping amounts for their prescriptions.
“Cap and smoothing”—as many patient advocates refer to these provisions—has bipartisan support and is long overdue. It is unacceptable that adults with Medicare insurance remain the only insured group in the U.S. without an annual cap on what they pay out of pocket for prescription medications.
In addition, the package proposes two other provisions that expand healthcare access for those who need it most.
The federal Low-Income Subsidy program, also called Extra Help, helps people with Medicare lower their prescription drug coverage costs. The Senate proposal would extend full benefits to people with household income up to 150 percent of the federal poverty level, which amounts to a family of two with a collective income of $27,465. Under the existing structure, they have only been eligible for a portion of the support they urgently need. This protection alone would significantly expand medication access for older adults with few other means.
And finally, certain vaccines, like shingles and tetanus—and all newly developed vaccines—will be free. Until now, older adults have faced high out-of-pocket costs for vaccines under Medicare Part D, leading many to forgo preventive vaccines because of the price.
Americans need relief today to afford their medications and vaccines. How much longer will Congress make them wait? It is time to pass these critical healthcare access reforms.
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