Key findings from a national survey on capping out-of-pocket costs

By Dan Klein, President and CEO and Amy Niles, Vice President of External Relations
Woman filing a claim on a computer

A recent national survey conducted by Morning Consult for the Alliance for Aging Research with support from the PAN Foundation surveyed 2,203 adults over age 60 with health insurance around their ability to pay for healthcare and to gauge support for limiting what seniors pay out-of-pocket for prescription drugs under Medicare Part D.

Overall, the survey revealed that one in five adults taking prescription drugs struggle to pay for them each month, and that a majority support legislation that would cap what seniors pay out-of-pocket for prescription drugs in the Medicare Part D program, including paying slightly higher premiums in exchange for a cap.

Read on for three key findings from the Alliance for Aging Research survey:

Finding 1: Older adults with chronic conditions are forgoing their medications due to cost.

In the survey, 1 in 5 adults said they struggle to pay for their prescriptions each month—and 1 in 4 with a chronic condition reported having stopped taking a prescription medication because of the cost.

The survey results confirm previous research: when a person struggles to afford their medication, they are more likely to forgo the treatment. Even with a medication copay as low as $40, many people choose not to fill their prescription.

There is a clear and growing need to address the financial burden of out-of-pocket costs for prescription medications so that older adults can access their critical medical treatment.

Finding 2: A majority of adults over 60 support a cap on out-of-pocket costs for prescription drugs, with a preference for a monthly cap.

A large majority (75%) of adults over age 60 said they would support legislation for a Medicare Part D cap that would limit what seniors pay for out-of-pocket for prescription medications.

When asked to choose between the option of a monthly or annual cap out on-out-pocket costs, 46 percent said they would support a monthly cap versus 24 percent who support an annual cap.

Currently, older adults on Medicare Part D are the only group of insured people in the U.S. without a cap on annual out-of-pocket costs. We see the consequences of this daily in our work here at the PAN Foundation.

Finding 3: Over half of adults over the age of 65 would be willing to pay a few dollars more each month for their Medicare premiums to allow a cap on out-of-pocket costs.

More than half (52 percent) of Medicare beneficiaries responded that they would be willing to pay an additional $4-$8 per month for their Medicare premium in exchange for a cap or limit placed on out-of-pocket costs in the Part D prescription drug benefit.

Support for a Medicare Part D cap may reflect a growing concern from older adults about their ability to pay for the out-of-pocket costs of their prescription drugs. In the current Medicare Part D program design, there no cost-sharing limit once a beneficiary reaches the catastrophic coverage phase, often requiring thousands of dollars per year out-of-pocket to stay on treatment for serious conditions like cancer, multiple sclerosis and rheumatoid arthritis, according to the Kaiser Family Foundation.

These findings contribute to the growing body of research that high out-of-pocket costs for prescription medications are both a financial burden and barrier to accessing medically necessary healthcare.

The PAN Foundation supports an out-of-pocket cap in Medicare Part D in order to increase access to treatment for the 45 million Americans who depend on the program for their prescription medications. Read more about our support for Medicare Part D reforms here.