Cap on out-of-pocket costs for Medicare drug plan enrollees coming soon – Herb Weiss

by Herb Weiss, contributing writer on aging issue

Back on Aug. 16th in 2022, President Joe Biden signed into law the Inflation Reduction Act of 2022 (IRA), it’s enactment lowering the health cost for millions of older Americans by lowering the high cost of prescription drugs by granting Medicare the power to directly negotiate drug prices with drug companies.  Rising drug costs were forcing some Medicare beneficiaries to cut their expenses by not filling a prescription or even skipping doses. This could lead to complications and side effects resulting in hospitalization, even death.

“AARP was instrumental in Congress passing the prescription drug law of 2022 to lower prices and out-of-pocket costs for Medicare enrollees,” said Jo Ann Jenkins, CEO of AARP in an Aug. 28 statement announcing the release of AARP’s new report. “As we approach January 2025, we want every senior in America to know that, thanks to the new annual cap which limits their out-of-pocket costs, they will have more money to invest in their families, spend on their broader Health needs or simply save to achieve greater financial stability.”

Virtual Media Briefing Details Impact on IRA law

Last week, the Washington, DC-based AARP briefed the media on the state-level impact of the historic new federal protection for 56 million Medicare drug plan enrollees. The new law caps out-of-pocket prescription drug costs every year, beginning at $2,000 in January 2025. 

The nine-page Public Policy Institute report, released at the virtual media briefing, analyzes the number of enrollees (not receiving the Medicare low-income subsidy) that will benefit from the new cap by state, age, gender, and race between 2025 and 2029.

Nancy LeaMond, the chief advocacy and engagement officer for AARP, say putting the brakes to spiraling drug cost by enacting the IRA put money back into the pockets of millions of America’s retirees purchasing pharmaceuticals for their medical conditions. “Upwards of 95% of Americans, age 65 and older, have at least one chronic condition and close to 80% are dealing with 2 or more chronic conditions,” says LeaMond, like diabetes and heart disease, to debilitating neurological diseases like Parkinson’s and Ms.

“Prescription drugs are a lifeline, said LeaMond, stressing that medicine is only effective if you have the money to pay for it. The passage of IRA two years ago is already having a significant and positive impact on millions of Medicare beneficiaries who now don’t pay more than $35 a month for insulin and get free vaccines for things like shingles,” she noted. 

“There are even bigger savings coming down the pike, starting in January 2025. The total amount that folks enrolled in Medicare drug plans pay out of pocket for their prescriptions will be capped at $2,000 a year,” reports LeaMond.  

During the media briefing, Leigh Purvis, Prescription Drug Policy Principal, AARP Public Policy Institute, stated “one of the biggest challenges in the original Medicare Part D benefit was the lack of a cap on out-of-pocket spending.”  Even after reaching a certain limit, Medicare beneficiaries were still required to pay 5% of their drug costs, with no limit for those on expensive Medications, she said.

According to Purvis, out of pocket expenses could exceed $10,000 per year, “an unmanageable amount for anyone, but especially for a population with a Median annual income of $36,000. Because of this, AARP pushed for the inclusion of a cap on out-of-pocket spending for Medicare Part D, to be included in the IRA, she said.  And it was…

Purvis noted that 3 million Part D beneficiaries (who don’t receive the Medicare Part D low-income subsidy are expected to benefit from the $2,000 cap in 2025.  This number is expected to grow to over 4 million by 2029.  These Medicare drug plan enrollees would see average savings of roughly $1,100, or 56%, in 2025 for their prescription drugs. 

Purvis also gave a few other takeaways from the report.  On average,  approximately 1.4 million (40 percent) Medicare drug plan enrollees who reach the new out-of-pocket cap between 2025 and 2029 are estimated to see annual savings of $1,000 or more, and just over 420,000 (12 percent) will see savings of more than $3,000.  In addition, more than three-quarters of Medicare drug plan enrollees who will benefit in 2025 are between the ages of 65 and 84.

Finally, Paula Cunningham, AARP Michigan State Director (discussing a results of a state survey) and Diana Devito , who has lived with chronic lymphocytic leukemia for over 19 years, participated in the media briefing. Both reinforced  how the report’s numbers aren’t just statistics, they represent real people “who are being forced to make impossible choices.” 

Cunningham told a “heartbreak” story about a woman who had lost her husband, and she had to sell her wedding ring in order to pay for her prescription drugs. “She’s now deceased, but I will never forget her story, or the stories of people across this great state that we met who had to make difficult choices between paying rent or buying groceries to pay for their medications,” she said.

After experiencing the high prescription costs for treating life-threatening chronic disorder, Devito came to share how important a $2,000 cap can be “for people like me.”  She said, “It’s a real-life changer,” noting that everyone doesn’t understand that. “If you’re not taking one of these expensive drugs, you don’t realize the impact that it has on your life,” she added.

On Another Note…

U.S. Senator Jack Reed brings to my attention another Congressional report that details the Rhode Island specific data as to the impact of IRA on older Rhode Islanders.

According to the Congressional Joint Economic Committee (CJEC), this year, about 57,000 Rhode Island Medicare beneficiaries will save an average of roughly $200 each year because of IRA’s improvement to the Medicare Part D drug coverage. By 2025 this number would increase to 68,000 retirees, saving them an annual average of $340 on prescription drugs.

By allowing Medicare to negotiate with drug companies to bargain down the high cost of many lifesaving drugs, 29,000 retirees use drugs that are with the new negotiated prices, says the CJEC report.

For a copy of AARP Public Policy Institute’s Medicare Part D Out-of-Pocket Spending Cap, go to https://www.aarp.org/pri/topics/health/prescription-drugs/medicare-part-d-out-of-pocket-spending-cap-prescription-drug-costs/.

To learn more about AARP’s work to lower prescription drug prices, visit https://www.aarp.org/politics-society/advocacy/prescription-drugs/.

For a copy of CJEC’s report, go to https://www.jec.senate.gov/public/_cache/files/356ae3d2-af5e-4d32-bd42-fafc548173c5/ri-cost-savings-fact-sheet.pdf

For details how the IRA impacts older Rhode Island retirees, go to https://www.whitehouse.gov/wp-content/uploads/2022/08/Rhode-Island-Health-Care.pdf

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To read more articles by Herb Weiss, go to: https://rinewstoday.com/herb-weiss/

Herb Weiss, LRI -12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 43 years. To purchase his books, Taking Charge: Collected Stories on Aging Boldly and a sequel, compiling weekly published articles, go to herbweiss.com.