Harris Mayer reports for Kaiser Health News that older adults and people with disabilities with costly medication needs are struggling to pay for their medications because Congress has failed to put an out-of-pocket cap on the Medicare Part D prescription drug benefit. In fact, tens of millions of Americans are hard-pressed to fill their prescriptions because Congress has failed to rein in drug prices.
Mayer describes one cancer drug that costs $18,000 for a four-week supply. Even for people with Medicare, out-of-pocket costs are nearly $1,000 a month. Once you reach the Medicare Part D catastrophic cap, you are liable for five percent of the list price unless your income is very low and you qualify for the Extra Help program.
Beware: Medicare Part D prescription drug plans, which are run by for-profit health insurance corporations, have been found to wrongly deny coverage. The federal government has imposed penalties on several Part D drug plans, but oversight does not keep them from continuing to wrongly deny coverage. If your Medicare Part D plan denies you coverage for drugs your doctor says you need, take these five simple steps.
About one million people with Medicare reach the catastrophic coverage level and, on average, spend $3,200 a year for their drugs. If they are taking one of 11 oral cancer drugs, their average annual out-of-pocket cost is $10,470. With a median annual income of $26,000, older adults and people with disabilities generally must scramble to find foundations that will help with their costs. How many do not succeed? It takes a lot of time, a lot of energy and a lot of perseverance.
The Leukemia and Lymphoma Society reports that less than half of people with Medicare diagnosed with blood cancer got treatment in the three months following their diagnosis.
Foundations are allowed to provide financial assistance to people with Medicare who need help with drug costs so long as they are helping with the costs of drugs sold by multiple prescription drug companies. The PAN Foundation provides help with copays to more than 100,000 people each year.
People with Medicare have lower out-of-pocket costs if they take drugs administered at the hospital. Medicare Part A covers the cost of those drugs. If they have supplemental coverage that fills gaps in traditional Medicare, they might have no out-of-pocket costs. If they are in a Medicare Advantage plan, their out-of pocket costs could be as high as $7,550 in 2021.
Of course, the problem is not restricted to people with Medicare. It’s always survival of the fittest when it comes to getting needed medicines. But, many employer plans have out-of-pocket limits on prescription drugs.
Fortunately, President-elect Joe Biden supports capping out-of-pocket drug costs for people with Medicare. But, unless Congress reins in drug prices, a cap could simply mean higher premiums for everyone. And, a cap could be an incentive for drug companies to raise Medicare drug prices further.
Here’s more from Just Care:
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