Help seniors stay on treatment by capping Part D

Did you know that Medicare beneficiaries are the only group of insured people in the US that are not protected by a cap on annual out-of-pocket costs? Hard to believe, but it’s true. We see the consequences of this on a daily basis here at the PAN Foundation.

The patients and caregivers who contact PAN for financial assistance are often facing thousands of dollars in out-of-pocket costs for their critical prescription medications. It is not unusual for patients with illnesses such as cancer, multiple sclerosis or hepatitis C to have to pay between $5,000 and $10,000+ annually in out-of-pocket costs for their essential medications.

To make matters worse, patients may need to pay thousands of dollars out-of-pocket for their prescriptions in January alone, because of their annual deductible. This puts individuals and families in incredibly challenging situations, forcing them to choose between paying for treatment, their mortgage or the weekly groceries. The diagnosis of a serious illness is difficult enough; adding in financial stress makes a bad situation worse.

Research tells us just how hard it is for these individuals to successfully commit to treatment when facing high out-of-pocket costs. Patients with serious illnesses and high out-of-pocket costs are less likely to fill their prescriptions, take longer to start their treatment, and experience increased interruptions and gaps in treatment.

Studies also show that even with a medication co-pay as low as $40, many patients choose not to fill their prescriptions. For the 45 million Americans who depend on Medicare Part D for their drug coverage, such a decision can have monumental repercussions on their health and wellbeing.

Establishing an annual out-of-pocket cap for Medicare Part D would make a tremendous difference for the patients we serve. An out-of-pocket cap would limit the amount Medicare beneficiaries must pay for their prescription drugs, putting them on safer financial ground and allowing them to more easily start and stay on treatment. Additionally, spreading the annual cap evenly from one month to the next would further alleviate financial burden for seniors.

We are proud to join MAPRx and 55 other leading organizations as we advocate for Part D Medicare reforms that put patients first. I hope you will do your share to advocate for lower out-of-pocket costs for seniors. To learn more about PAN’s advocacy positions, click here.