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PAN advocates for two key policy solutions that will modernize Medicare Part D, offer improved access to healthcare for 45 million people, and lower out-of-pocket costs.
- An annual cap on out-of-pocket prescription medication costs that will place a limit on what older adults and people with disabilities pay for their treatment.
- Evenly distributing out-of-pocket prescription medication costs throughout the year to help patients better anticipate and plan for their medication expenses—instead of paying extraordinary sums at the beginning of each calendar year.
Medicare Part D is a critical program that makes drugs accessible to Medicare eligible individuals.
- 45 million or 75 percent of the more than 60 million people on Medicare are enrolled in a Part D plan.
Medicare enrollees need assistance in paying for their medications.
- Many people with Medicare live on fixed or limited incomes. Paying high out-of-pocket costs for medications is difficult, if not impossible.
- Currently, half of all Medicare beneficiaries—nearly 30 million older adults and people with disabilities—live on $26,200 or less per year. (Kaiser Family Foundation)
- Medicare Part D enrollees who did not receive low-income subsidies spent about $500 out-of-pocket on their prescriptions in 2016, on average, but 1 million enrollees with spending above the catastrophic threshold spent nearly $3,200 out of pocket. (Kaiser Family Foundation)
Healthcare costs are taking up a larger and more disproportionate share of beneficiaries’ limited budgets
- Out-of-pocket costs for prescription drugs represent a significant share of out-of-pocket expenses, accounting for nearly one out of every five beneficiary healthcare dollars. (Kaiser Family Foundation)
- Medicare Part D enrollees can pay thousands of dollars out of pocket for specialty tier drugs, with the majority of costs for many specialty drugs occurring in the catastrophic phase of the benefit. (Kaiser Family Foundation)
Seniors are making lifestyle changes and healthcare decisions to afford their medications.
Morning Consult conducted an online survey among a sample of 1,000 Medicare beneficiaries with chronic conditions taking medications. Since the start of 2020, seniors on Medicare with high out-of-pocket prescription drug costs have made lifestyle changes to afford their prescription drugs:
- Over half (56 percent) reduced spending on nonessential activities.
- 49 percent reduced spending on every-day purchases.
- 34 percent tapped into emergency savings.
High out-of-pocket costs impact medication adherence.
- Nearly 1 in 4 Americans who take prescription medications say it is difficult to afford them. (Kaiser Family Foundation)
- Economically vulnerable older adults are at particularly high risk for non-adherence.
- A 2019 tracking poll found that 29 percent of older adults did not take their medicines as prescribed at some point in the past year because of the cost. (Kaiser Family Foundation)