The proposed reconciliation bill falls short for Medicare beneficiaries

The PAN Foundation is disappointed that critical provisions to restructure Medicare Part D, including a cap on out-of-pocket prescription costs, have been eliminated from the administration’s proposed domestic tax and spending package, and urges Congress to restore these patient-centric policies. 

Despite overwhelming popularity across the country, and across party lines, the framework announced by President Joe Biden on Thursday did not include a cap on out-of-pocket spending or a smoothing mechanism that would allow Medicare beneficiaries to pay for their medications throughout the year. Medicare beneficiaries, one of the most vulnerable populations in the U.S., remain the only insured group in the country who have no limit on what they pay out-of-pocket each year for prescription drugs.  

“There are 48 million people on Medicare Part D, and each one is a serious diagnosis away from choosing between critical medications and forfeiting their life savings,” said PAN President and CEO Kevin L. Hagan. “Congress should set politics aside and focus on what’s most impactful to the seniors and people with disabilities who rely on Medicare Part D for their prescriptions. They have waited for too long already for relief at the pharmacy counter. We strongly urge Congress to include cap and smoothing in the Build Back Better Act.” 

Studies and surveys continue to show that the cost of prescriptions are beyond the means of far too many. Seniors may cut back on their groceries or go into credit card debt to afford their medications. Others are simply not taking the prescriptions they need. According to a study by the Kaiser Family Foundation, the average annual out-of-pocket cost in 2019 for patients requiring a specialty medication was more than $8,000. But according to polling by Morning Consult in 2021, 75 percent of seniors reported that they can’t afford to pay more than $200 each month.

Before voting on this reconciliation bill, it must include the following Medicare reforms: 

  • An annual cap on patient medication costs: A monthly or annual cap would facilitate access to needed treatments, protect patients from high out-of-pocket costs, and help beneficiaries predict and plan for these costs throughout the year. 
  • Smoothing patient medication costs throughout the benefit year: Medicare Part D prescription drug plans concentrate out-of-pocket medication costs at the beginning of the year when deductibles and benefits reset. This cycle can have a devastating impact on patients who face high cost-sharing associated with medications for diseases such as Parkinson’s, cancer, diabetes, and Alzheimer’s disease. Most patients cannot afford large out-of-pocket expenses all at once or over a short period but could afford the total cost if spread out evenly throughout the benefit year. 

The PAN Foundation has long advocated for a cap and smoothing for Medicare Part D. Read more about our position on an annual cap and smoothing.    

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  more than 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    


Liz Eckert, Senior Director of Marketing and Communications