Health

It could get worse for seniors with high drug prices

Out-of-pocket costs for Medicare Part D to increase, analysis finds

Bottles of medications line the shelves in June 2017 at a pharmacy in Portsmouth, Ohio. (Reuters file photo)
Bottles of medications line the shelves in June 2017 at a pharmacy in Portsmouth, Ohio. (Reuters file photo)

Senior citizens with high prescription drug costs are facing hundreds of dollars in additional expenses next year, according to a new analysis of Medicare’s drug program by a nonprofit research group.

Medicare’s drug benefit, known as Part D, is complicated. Patients in the program have a deductible where they must pay 100 percent of the cost: $435 in 2020, according to the analysis by the Kaiser Family Foundation. After that, they pay a quarter of the costs until they reach the threshold for catastrophic coverage, when richer benefits kick in.

Next year, the catastrophic coverage threshold will go up by $1,250 — meaning people on brand-name drugs will pay about $400 more a year out-of-pocket, according to the analysis. People taking generics will pay even more.

High drug costs are a source of discontent among voters. Vying for 2020 voters, the Trump administration has boasted about its efforts to get pharmaceutical companies to lower list prices for medications, while ire at drugmakers and insurers has animated Democratic calls for a broader overhaul.

Next year’s rising costs stem from an expiring part of the Affordable Care Act, which temporarily tamped down increases in the catastrophic coverage threshold.

Medicare Part D covers about 44 million Americans on the federal health program for the elderly and disabled. Administered by private insurers, the program distributes the cost of medications among enrollees, health plans, drugmakers and the government. Low-income people in the program get subsidies to help.

In 2017, 4.9 million people had drug spending and incomes high enough that they either entered the coverage gap or went all the way through it, the Kaiser Family Foundation said.

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Above the catastrophic coverage level, seniors are on the hook for 5 percent of medication costs, with no upper limit.

Various legislative proposals would cap out-of-pocket costs for the Medicare drug benefit.

A bill supported by Democratic House Speaker Nancy Pelosi would limit seniors’ exposure to $2,000, while a proposal advanced by Republican Iowa Sen. Chuck Grassley’s Finance Committee would set the cap at $3,200.

The Trump administration has proposed insulating seniors from cost-sharing after they reach the catastrophic threshold. But whether Congress and the administration can agree on a prescription drug bill before the 2020 election remains an open question.

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