Healthcare policy priorities

How to make healthcare affordable: four strategies that can make a difference

Medical treatment must be more affordable and accessible to Medicare and commercially insured patients living with life-threatening and serious diseases.

Here are four practical ways for Congress and the Administration to advance this goal.

  • 1

    Place a monthly or annual cap on out-of-pocket costs for prescription medications.

Why a cap is needed: Medicare beneficiaries are the only group of insured people in the U.S. that is not protected by a cap on annual out-of-pocket costs, forcing many to make difficult trade-offs or to forgo treatment altogether.

  • 2

    Spread out-of-pocket costs for prescription medications more evenly throughout the benefit year.

Why smoothing is needed: The structure of Medicare Part D prescription drug plans front loads out-of-pocket medication costs early in the benefit year. This can have a devastating impact on patients who face high cost sharing for their medications.

  • 3

    Modernize the Medicare Part D Low-Income Subsidy (LIS) program to increase enrollment and provide continuity for individuals from one year to the next.

Why LIS should be modernized: Because the current eligibility criteria for the LIS program requires patients to have an extremely low income, millions of Medicare beneficiaries who are economically insecure but slightly above the limit are unable to afford their prescription medications.

  • 4

    Prohibit co-pay accumulators or similar programs that lead to greater out-of-pocket costs for individuals with life-threatening, chronic and rare diseases.

Why co-pay accumulators should be prohibited: Deductibles, co-pays, and coinsurance have increased dramatically in recent years and co-payment cards have become even more important for economically vulnerable patients. However, commercial insurance co-pay accumulator policies prevent patients from using co-pay cards and coupons to count toward their deductibles, resulting in a much larger overall out-of-pocket financial burden for patients.